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NPI Code Detail

MEDICARE: WYATT LAWRENCE URLACHER LCSW-PIP

MEDICARE: WYATT LAWRENCE URLACHER LCSW-PIP
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
11041C0700XClinical Social Worker5139SD

General Provider Information

NPI Number : 1457824344
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYATT LAWRENCE URLACHER LCSW-PIP
Provider Business Mailing Address
First Line : 1200 N WEST AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-1335
Country : US
Telephone Number : 605-339-0420
Fax Number : 605-339-0038
Provider Business Practice Location Address
First Line : 1200 N WEST AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-1335
Country : US
Telephone Number : 605-339-0420
Fax Number : 605-339-0038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2019
Last Update Date : 11/08/2024

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