Provider Demographics
NPI:1952579799
Name:PYEATT, JACQUELYN ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:ELIZABETH
Last Name:PYEATT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACQUELYN
Other - Middle Name:ELIZABETH
Other - Last Name:BONDURANT-DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 NORTH LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1110
Mailing Address - Country:US
Mailing Address - Phone:541-482-2509
Mailing Address - Fax:
Practice Address - Street 1:1515 SOUTH OREGON ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3475
Practice Address - Country:US
Practice Address - Phone:530-841-1783
Practice Address - Fax:530-841-0769
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical