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General NPI Number Information
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NPI Number | 1174952477
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Entity Type | Individual
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Provider Name | JENNIFER YEOWARD-DODSON PHD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 600 N EAGLESON AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47405-3190
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Country | US
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Telephone | 812-855-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N EAGLESON AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47405-3190
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Country | US
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Telephone | 812-855-5711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 20043804B
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License Number State | IN
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