Provider Demographics
NPI:1518085190
Name:YEDINAK, JESSE LYNNE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LYNNE
Last Name:YEDINAK
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 1:1927 GOSS ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6526
Mailing Address - Country:US
Mailing Address - Phone:303-746-4275
Mailing Address - Fax:
Practice Address - Street 1:1441 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6214
Practice Address - Country:US
Practice Address - Phone:303-440-4842
Practice Address - Fax:303-415-0413
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health