Basic Information
| Provider Information | |||||||||
| NPI: | 1942443460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAHNKE | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 COMMUNITY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647358804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608908186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1780 OLD HIGHWAY 50 E | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630843397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365828100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2009 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.00100008-SUPV | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 2015035971 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | I.0010008-SUPV | 01 | OH | LISW | OTHER |