Healthcare Provider Details

I. General information

NPI: 1730655424
Provider Name (Legal Business Name): REBECCA YETISKUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 CATASAUQUA RD
BETHLEHEM PA
18018-1008
US

IV. Provider business mailing address

2434 CATASAUQUA RD
BETHLEHEM PA
18018-1008
US

V. Phone/Fax

Practice location:
  • Phone: 412-638-2144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021789
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW135436
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: