Provider Demographics
NPI:1568743359
Name:PONDER, YOLANDA AMBER (LCSW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:AMBER
Last Name:PONDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:AMBER
Other - Last Name:CORNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:310 CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3624
Mailing Address - Country:US
Mailing Address - Phone:208-779-5008
Mailing Address - Fax:208-779-5009
Practice Address - Street 1:310 CLEVELAND BLVD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3624
Practice Address - Country:US
Practice Address - Phone:208-954-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID30867104100000X
ID33404261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker