Healthcare Provider Details

I. General information

NPI: 1033651179
Provider Name (Legal Business Name): JACQUELYN S BERKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 2ND ST
SIOUX CITY IA
51103-4506
US

IV. Provider business mailing address

420 W 2ND ST
SIOUX CITY IA
51103-4506
US

V. Phone/Fax

Practice location:
  • Phone: 712-600-4838
  • Fax:
Mailing address:
  • Phone: 712-600-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20006
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1329
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-21867
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11038
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number083744
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2277
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0019044
License Number StateCO
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number30775
License Number StateSD
# 9
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2548
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: