Individual
MRS. KIMBERLY KAY YEAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1902 OSAGE DR, COLUMBIA, MO 65202-5476
(573) 474-2984
Mailing address
1902 OSAGE DR, COLUMBIA, MO 65202-5476
(573) 474-2984
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004461
STATE OF MISSOURI LICENSE
MO
05
—
497695130
—
MO
Enumeration date
12/22/2005
Last updated
07/11/2020
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