Healthcare Provider Details

I. General information

NPI: 1841703501
Provider Name (Legal Business Name): BRANDY YEAROUT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 KOALA DR
OMAK WA
98841-9247
US

IV. Provider business mailing address

1007 KOALA DR
OMAK WA
98841-9247
US

V. Phone/Fax

Practice location:
  • Phone: 509-826-6191
  • Fax:
Mailing address:
  • Phone: 509-826-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number61423039
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61423039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: