MEDICARE: KRISTIN HERDMAN YELLAM LCSW, MSW

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	1041C0700X	Clinical Social Worker	LCS 22178	CA

General Provider Information

NPI Number	:	1760576482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN HERDMAN YELLAM LCSW, MSW

Provider Business Mailing Address
First Line	:	2085 RUSTIN AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-955-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2085 RUSTIN AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-955-7320
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/07/2021

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