1104078260 NPI number — MRS. JERRY L WEBBER LCSW

Table of content: MARGARET ELIZABETH HERRFELDT RD (NPI 1003181546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104078260 NPI number — MRS. JERRY L WEBBER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBBER
Provider First Name:
JERRY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
JERRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104078260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 W 23RD ST SUITE; 101
Provider Second Line Business Mailing Address:
HEARTLAND PWYCHOLOGICAL SERVICES
Provider Business Mailing Address City Name:
YANKTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57078-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-665-0841
Provider Business Mailing Address Fax Number:
605-665-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 W 23RD ST SUITE; 101
Provider Second Line Business Practice Location Address:
HEARTLAND PWYCHOLOGICAL SERVICES
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-665-0841
Provider Business Practice Location Address Fax Number:
605-665-0096
Provider Enumeration Date:
10/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2368 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)