1760830905 NPI number — MICHELLE SOBERALSKI MSW, LCSW, QMHP

Table of content: MICHELLE SOBERALSKI MSW, LCSW, QMHP (NPI 1760830905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760830905 NPI number — MICHELLE SOBERALSKI MSW, LCSW, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBERALSKI
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, QMHP
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:
1760830905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 US HWY 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57702-7351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-343-2811
Provider Business Mailing Address Fax Number:
605-341-7437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 US 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57702-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-343-2811
Provider Business Practice Location Address Fax Number:
605-341-7437
Provider Enumeration Date:
05/27/2016

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com