Provider Demographics
NPI:1912364852
Name:JASSO, YOLANDA BALDERAS
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:BALDERAS
Last Name:JASSO
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 1:242 N MAGDALEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5434
Mailing Address - Country:US
Mailing Address - Phone:325-944-2561
Mailing Address - Fax:325-653-4218
Practice Address - Street 1:242 N MAGDALEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5434
Practice Address - Country:US
Practice Address - Phone:325-944-2561
Practice Address - Fax:325-653-4218
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical