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General NPI Number Information
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NPI Number | 1477805471
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Entity Type | Individual
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Provider Name | JENNIFER YETTER BERBACH LSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 1100 N. COLLEGE STREET VETERANS HEALTH CARE SYSTEM OF THE OZARKS
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-443-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 6004 PLEASANT DR
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City | ROGERS
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State | AR
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Zip | 72758-9581
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Country | US
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Telephone | 573-842-5292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW125823
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License Number State | PA
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