Provider Demographics
NPI:1639302391
Name:YECKER, SANDRA ANN (PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:YECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ECHO VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:NEFFSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3720
Mailing Address - Country:US
Mailing Address - Phone:347-204-5931
Mailing Address - Fax:
Practice Address - Street 1:32 ECHO VALLEY LN
Practice Address - Street 2:
Practice Address - City:NEFFSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17601-3720
Practice Address - Country:US
Practice Address - Phone:347-204-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017845-1103TC0700X
PAPS016839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical