Healthcare Provider Details

I. General information

NPI: 1467604215
Provider Name (Legal Business Name): GLENADENE AAMOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W CEDAR ST
BERESFORD SD
57004-1524
US

IV. Provider business mailing address

1109 W CEDAR ST
BERESFORD SD
57004-1524
US

V. Phone/Fax

Practice location:
  • Phone: 605-763-5096
  • Fax: 605-763-2206
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17990-6
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: