MEDICARE: DR. GLADYS LEE YAHNKE PSY.D.

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	103T00000X	Psychologist	2978	CO

General Provider Information

NPI Number	:	1932272937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLADYS LEE YAHNKE PSY.D.

Provider Business Mailing Address
First Line	:	6116 BIGHORN XING
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6544
Country	:	US
Telephone Number	:	970-631-4661
Fax Number	:	970-797-1349

Provider Business Practice Location Address
First Line	:	375 E HORSETOOTH RD
Second Line	:	BLDG 2 STE 201
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3155
Country	:	US
Telephone Number	:	970-631-3037
Fax Number	:	970-797-1349

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	04/07/2008

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