Provider Demographics
NPI:1235326786
Name:YAEGER, AMY MICHELLE (ASW)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:MICHELLE
Last Name:YAEGER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 KIHAPAI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2612
Mailing Address - Country:US
Mailing Address - Phone:833-922-1092
Mailing Address - Fax:
Practice Address - Street 1:74 KIHAPAI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2612
Practice Address - Country:US
Practice Address - Phone:833-922-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4353101YM0800X, 1041C0700X
104100000X
CA65807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical