Provider Demographics
NPI:1073133831
Name:YANDOW, GWYNN (MSW,LICSW)
Entity Type:Individual
Prefix:
First Name:GWYNN
Middle Name:
Last Name:YANDOW
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-4277
Mailing Address - Country:US
Mailing Address - Phone:802-257-0074
Mailing Address - Fax:
Practice Address - Street 1:21 ROBIN WAY
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-4277
Practice Address - Country:US
Practice Address - Phone:802-257-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00005191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical