1326605445 NPI number — MS. CONSTANCE KATHRYN BIRGEN ED.S., LPC-MH, LAC,

Table of content: MS. CONSTANCE KATHRYN BIRGEN ED.S., LPC-MH, LAC, (NPI 1326605445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326605445 NPI number — MS. CONSTANCE KATHRYN BIRGEN ED.S., LPC-MH, LAC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRGEN
Provider First Name:
CONSTANCE
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S., LPC-MH, LAC,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326605445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 S LOUISE AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57106-3124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-638-0477
Provider Business Mailing Address Fax Number:
605-334-5348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 W 23RD ST STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-334-7713
Provider Business Practice Location Address Fax Number:
605-334-5348
Provider Enumeration Date:
05/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPCMH20178 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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