Healthcare Provider Details

I. General information

NPI: 1316361959
Provider Name (Legal Business Name): JENNIFER LEA YEPMA LCSW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S 12TH ST
WACO TX
76701-1810
US

IV. Provider business mailing address

140 STEELE
KYLE TX
78640-5882
US

V. Phone/Fax

Practice location:
  • Phone: 254-752-3451
  • Fax: 254-756-3133
Mailing address:
  • Phone: 254-300-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number56243
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: