Provider Demographics
NPI:1760655401
Name:YEZIORNA, BARBARA (MSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:YEZIORNA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:WAITE-WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2211 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1803
Mailing Address - Country:US
Mailing Address - Phone:314-394-0246
Mailing Address - Fax:
Practice Address - Street 1:2211 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1803
Practice Address - Country:US
Practice Address - Phone:314-394-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010311761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical