Healthcare Provider Details

I. General information

NPI: 1871009845
Provider Name (Legal Business Name): KASSIE BREITKREUTZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 AIRPORT AVE
BROOKINGS SD
57006-1852
US

IV. Provider business mailing address

1105 W RUSSELL ST
SIOUX FALLS SD
57104-1322
US

V. Phone/Fax

Practice location:
  • Phone: 605-906-8801
  • Fax: 605-271-3956
Mailing address:
  • Phone: 605-271-2690
  • Fax: 605-271-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: