Healthcare Provider Details

I. General information

NPI: 1972424422
Provider Name (Legal Business Name): COURTNEY NICOLE DEJONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TERRACE RD
CHAMBERLAIN SD
57325-1645
US

IV. Provider business mailing address

4100 S ELMWOOD PL
SIOUX FALLS SD
57105-6573
US

V. Phone/Fax

Practice location:
  • Phone: 605-391-9619
  • Fax:
Mailing address:
  • Phone: 605-607-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number186
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: