Healthcare Provider Details

I. General information

NPI: 1235065962
Provider Name (Legal Business Name): BRUCE BENJAMIN JOSEPH KARDELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 HAMILTON BLVD LOWR A
SIOUX CITY IA
51104-2423
US

IV. Provider business mailing address

3000 CHEYENNE BLVD
SIOUX CITY IA
51104-2807
US

V. Phone/Fax

Practice location:
  • Phone: 712-258-4553
  • Fax:
Mailing address:
  • Phone: 712-363-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: