Provider Demographics
NPI:1114055399
Name:HERN, YOLANDA M (LISW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:M
Last Name:HERN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 S 4TH ST
Mailing Address - Street 2:SANTA ROSA CONSOLIDATED SCHOOL DISTRICT
Mailing Address - City:SANTA ROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88435-2325
Mailing Address - Country:US
Mailing Address - Phone:505-472-3172
Mailing Address - Fax:
Practice Address - Street 1:344 S 4TH ST
Practice Address - Street 2:SANTA ROSA CONSOLIDATED SCHOOL DISTRICT
Practice Address - City:SANTA ROSA
Practice Address - State:NM
Practice Address - Zip Code:88435-2325
Practice Address - Country:US
Practice Address - Phone:505-472-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-41511041C0700X
NM2478341041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool