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General NPI Number Information
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NPI Number | 1568743359
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Entity Type | Individual
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Provider Name | YOLANDA AMBER PONDER LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 310 CLEVELAND BLVD
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City | CALDWELL
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State | ID
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Zip | 83605-3624
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Country | US
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Telephone | 208-954-0597
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Fax |
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Provider Business Mailing Address
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Address Line | 310 CLEVELAND BLVD
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City | CALDWELL
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State | ID
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Zip | 83605-3624
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Country | US
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Telephone | 208-779-5008
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Fax | 208-779-5009
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 30867
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 33404
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License Number State | ID
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