Provider Demographics
NPI:1629436639
Name:YELLOW OWL, JEFFREY (MSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:YELLOW OWL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S TOPPENISH AVE
Mailing Address - Street 2:POB 151
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1780
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:509-865-2064
Practice Address - Street 1:217 S TOPPENISH AVE
Practice Address - Street 2:POB 151
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1780
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:509-865-2064
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602909311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical