Provider Demographics
NPI:1508995556
Name:YODER, QUEEN (MSW)
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 RAINBOW BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2030
Mailing Address - Country:US
Mailing Address - Phone:574-522-1570
Mailing Address - Fax:
Practice Address - Street 1:1004 PARKWAY AVE STE D
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9349
Practice Address - Country:US
Practice Address - Phone:574-293-0005
Practice Address - Fax:574-293-0019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical