Provider Demographics
NPI:1265107379
Name:YONKER, TIERRA
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:YONKER
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:N4590 HWY 45
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:WI
Mailing Address - Zip Code:53019-1212
Mailing Address - Country:US
Mailing Address - Phone:920-904-6445
Mailing Address - Fax:920-477-3777
Practice Address - Street 1:N4590 HWY 45
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:WI
Practice Address - Zip Code:53019-1212
Practice Address - Country:US
Practice Address - Phone:920-904-6445
Practice Address - Fax:920-477-3777
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13122-1211041C0700X
WI16047-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical