Provider Demographics
NPI:1235680901
Name:YEAGER, PAM (LISW-S)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:YEAGER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N FORGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1317
Mailing Address - Country:US
Mailing Address - Phone:330-762-0591
Mailing Address - Fax:
Practice Address - Street 1:1865 BAILEY RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5211
Practice Address - Country:US
Practice Address - Phone:330-928-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142484-M-IV164W00000X
OHI.2002131-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2002131-SUPRMedicaid