Provider Demographics
NPI:1063169894
Name:YODER, ALICIA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:YODER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 PINE LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5938
Mailing Address - Country:US
Mailing Address - Phone:909-730-2000
Mailing Address - Fax:
Practice Address - Street 1:21101 DALE EVANS PKWY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-9356
Practice Address - Country:US
Practice Address - Phone:760-916-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1270311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker