Provider Demographics
NPI:1295855989
Name:YEEND, ANGELA JOANN
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JOANN
Last Name:YEEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 S 725 W
Mailing Address - Street 2:
Mailing Address - City:MANILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46150-9713
Mailing Address - Country:US
Mailing Address - Phone:317-512-0292
Mailing Address - Fax:765-525-5849
Practice Address - Street 1:7012 S 725 W
Practice Address - Street 2:
Practice Address - City:MANILLA
Practice Address - State:IN
Practice Address - Zip Code:46150-9713
Practice Address - Country:US
Practice Address - Phone:317-512-0292
Practice Address - Fax:765-525-5849
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN746576320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities