MEDICARE: MISS YOLANDA JO DEED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1083838502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YOLANDA JO DEED

Provider Business Mailing Address
First Line	:	4232 PACIFIC AVE #27
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207
Country	:	US
Telephone Number	:	209-477-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W HOSPITAL RD
Second Line	:
City	:	FRENCH CAMP
State	:	CA
Zip	:	95231
Country	:	US
Telephone Number	:	209-468-6985
Fax Number	:	209-468-6739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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