MEDICARE: DONNA MARIE EPP

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	1084	SD
2	106H00000X	Marriage & Family Therapist	LMFT1153	SD
3	1041C0700X	Clinical Social Worker	4150	ND

General Provider Information

NPI Number	:	1871993451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MARIE EPP

Provider Business Mailing Address
First Line	:	610 GRAND AVE
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2008
Country	:	US
Telephone Number	:	605-214-4578
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 GRAND AVE
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2008
Country	:	US
Telephone Number	:	605-214-4578
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/05/2014

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Directions to “ DONNA MARIE EPP ” Practice Location

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