Provider Demographics
NPI:1851709166
Name:YEAGER, JOSHUA R (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:YEAGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N ELM ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3637
Mailing Address - Country:US
Mailing Address - Phone:630-850-2120
Mailing Address - Fax:630-850-2123
Practice Address - Street 1:908 N ELM ST STE 207
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3637
Practice Address - Country:US
Practice Address - Phone:630-850-2120
Practice Address - Fax:630-850-2123
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071008862OtherIL PSYCHOLOGIST CLINICAL