Provider Demographics
NPI:1043904428
Name:YANEZ, JAKE
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:YANEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 ABBOT RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1410
Mailing Address - Country:US
Mailing Address - Phone:517-721-1313
Mailing Address - Fax:616-259-4835
Practice Address - Street 1:6102 ABBOT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1410
Practice Address - Country:US
Practice Address - Phone:517-721-1313
Practice Address - Fax:616-259-4835
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician