Provider Demographics
NPI:1477805471
Name:BERBACH, JENNIFER YETTER (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YETTER
Last Name:BERBACH
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9581
Mailing Address - Country:US
Mailing Address - Phone:573-842-5292
Mailing Address - Fax:
Practice Address - Street 1:1100 N. COLLEGE STREET
Practice Address - Street 2:VETERANS HEALTH CARE SYSTEM OF THE OZARKS
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-443-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker