Healthcare Provider Details

I. General information

NPI: 1275689028
Provider Name (Legal Business Name): JENNIFER SCHRADER YEAW PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP
FORT HOOD TX
76544-4752
US

IV. Provider business mailing address

1218 N WALL ST
BELTON TX
76513-2158
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-2284
  • Fax:
Mailing address:
  • Phone: 210-508-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32570
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: