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NPI Code Detail

MEDICARE: MICHELE MARIE CLODFELDER MS, LPC-MH

MEDICARE: MICHELE MARIE CLODFELDER MS, LPC-MH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC-MH20361SD

General Provider Information

NPI Number : 1194108829
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE MARIE CLODFELDER MS, LPC-MH
Provider Business Mailing Address
First Line : 310 S 26TH ST STE 1
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-3355
Country : US
Telephone Number : 605-580-7358
Fax Number : 605-559-0321
Provider Business Practice Location Address
First Line : 310 S 26TH ST STE 1
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-3355
Country : US
Telephone Number : 605-580-7358
Fax Number : 605-559-0321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2015
Last Update Date : 03/07/2024

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