Provider Demographics
NPI:1740950005
Name:YAGER, AMY CHRISTINE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:YAGER
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-0013
Mailing Address - Country:US
Mailing Address - Phone:617-783-7529
Mailing Address - Fax:618-248-0551
Practice Address - Street 1:102 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1900
Practice Address - Country:US
Practice Address - Phone:618-783-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician