Healthcare Provider Details

I. General information

NPI: 1205358363
Provider Name (Legal Business Name): RAVEN DON WEBER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 E JOHNSON AVE
JONESBORO AR
72405-1874
US

IV. Provider business mailing address

2712 E JOHNSON AVE
JONESBORO AR
72405-1874
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-2800
  • Fax:
Mailing address:
  • Phone: 870-393-5335
  • Fax: 870-932-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11526-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: