Provider Demographics
NPI:1003284142
Name:HERTICH, YVONNE (MSW)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:HERTICH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1120
Mailing Address - Country:US
Mailing Address - Phone:414-530-8615
Mailing Address - Fax:
Practice Address - Street 1:8949 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2621
Practice Address - Country:US
Practice Address - Phone:314-329-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MO2018021289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker