Provider Demographics
NPI:1679313910
Name:YEAGER, STACY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:YEAGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5796 N MORLEAU LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-0424
Mailing Address - Country:US
Mailing Address - Phone:208-660-5382
Mailing Address - Fax:
Practice Address - Street 1:212 S 11TH ST STE 3
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4000
Practice Address - Country:US
Practice Address - Phone:208-930-1275
Practice Address - Fax:208-930-0330
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID45187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health