Healthcare Provider Details

I. General information

NPI: 1750604120
Provider Name (Legal Business Name): KAREN SUE SEVERNS PSYD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KAREN SUE VASSAR

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH AVE
ABERDEEN SD
57401
US

IV. Provider business mailing address

115 4TH AVE
ABERDEEN SD
57401
US

V. Phone/Fax

Practice location:
  • Phone: 605-846-7193
  • Fax: 208-686-5813
Mailing address:
  • Phone: 605-846-7193
  • Fax: 208-686-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32878
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW27799
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-10368
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10666
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: