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NPI Code Detail

MEDICARE: GERUSALEM YIGZAW

MEDICARE: GERUSALEM YIGZAW
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1528915873
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERUSALEM YIGZAW
Provider Business Mailing Address
First Line : 2405 PALMER CIR STE 100
Second Line :
City : NORMAN
State : OK
Zip : 73069-6351
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 189 N PLANO RD STE 100
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-8001
Country : US
Telephone Number : 855-782-7822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ GERUSALEM YIGZAW ” Practice Location

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