Provider Demographics
NPI:1720091879
Name:YERKA, EDWIN CHARLES (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CHARLES
Last Name:YERKA
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:507-401-2060
Practice Address - Fax:866-260-1396
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2281409OtherUNITED HEALTHCARE
MN50M21YEOtherBLUE CROSS BLUE SHIELD
MN680015067OtherRR MEDICARE
MN1032344OtherPREFERRED ONE
MN143659OtherUCARE
MN61-53867OtherMEDICA
MNHP37854OtherHEALTH PARTNERS
MN156835300Medicaid
MN30281OtherSIOUX VALLEY HEALTH
MN1032344OtherPREFERRED ONE