MEDICARE: JAMES D KIENITZ MSW

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
1	1041C0700X	Clinical Social Worker	407	SD

General Provider Information

NPI Number	:	1821092818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D KIENITZ MSW

Provider Business Mailing Address
First Line	:	353 FAIRMONT BLVD
Second Line	:	ATTEN MEDICAL STAFF SERVICES
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 LAZELLE ST
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785
Country	:	US
Telephone Number	:	605-720-2600
Fax Number	:	605-720-2611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/05/2013

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