Individual
KEN R YODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000514A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202049
ANTHEM
—
01
—
P00102953
RAILROAD MEDICARE PIN
—
Enumeration date
06/08/2006
Last updated
08/08/2011
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