Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 23667 | MN |
N | 104100000X | Social Worker | 69153 | TX |
NPI | 1003433921 |
---|---|
Provider Name | Edward Alan Yurick |
First Address | Baxter, MN 56425-4201 |
Second Address | Baxter, MN 56425-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2020 |
Last Update Date | 09/08/2021 |