Provider Demographics
NPI:1033180575
Name:YODER, EDITH A (MSSA, LCSW)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:A
Last Name:YODER
Suffix:
Gender:F
Credentials:MSSA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 E MARYLAND AVE
Mailing Address - Street 2:SUITE C-101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1469
Mailing Address - Country:US
Mailing Address - Phone:602-266-2282
Mailing Address - Fax:602-266-1171
Practice Address - Street 1:1536 E MARYLAND AVE
Practice Address - Street 2:SUITE C-101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1469
Practice Address - Country:US
Practice Address - Phone:602-266-2282
Practice Address - Fax:602-266-1171
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-06581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical