Provider Demographics
NPI:1043344849
Name:ED YERKA PSYCHOLOGICAL CONSULTANT, PLLC
Entity Type:Organization
Organization Name:ED YERKA PSYCHOLOGICAL CONSULTANT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YERKA
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:507-530-2837
Mailing Address - Street 1:506 W THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2244
Mailing Address - Country:US
Mailing Address - Phone:507-530-2837
Mailing Address - Fax:866-260-1396
Practice Address - Street 1:238 W MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1398
Practice Address - Country:US
Practice Address - Phone:507-401-2026
Practice Address - Fax:662-601-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN816137000Medicaid
MNC04578Medicare PIN