Provider Demographics
NPI:1881722742
Name:YENNEY, DALE A (MSW)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:A
Last Name:YENNEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21587 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WORLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83876-7614
Mailing Address - Country:US
Mailing Address - Phone:208-769-7127
Mailing Address - Fax:
Practice Address - Street 1:21587 S LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:WORLEY
Practice Address - State:ID
Practice Address - Zip Code:83876-7614
Practice Address - Country:US
Practice Address - Phone:208-769-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000043071041C0700X
IDLCSW-4591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical