Provider Demographics
NPI:1104078260
Name:WEBBER, JERRY L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JERRY
Middle Name:L
Last Name:WEBBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:904 W 23RD ST SUITE; 101
Mailing Address - Street 2:HEARTLAND PWYCHOLOGICAL SERVICES
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-1206
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:904 W 23RD ST SUITE; 101
Practice Address - Street 2:HEARTLAND PWYCHOLOGICAL SERVICES
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1206
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD23681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical