Provider Demographics
NPI:1902362247
Name:YEATES, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:YEATES
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 1:6010 COMMERCE BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2127
Mailing Address - Country:US
Mailing Address - Phone:707-586-3295
Mailing Address - Fax:
Practice Address - Street 1:6010 COMMERCE BLVD STE 145
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2127
Practice Address - Country:US
Practice Address - Phone:707-586-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS42291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical