Healthcare Provider Details

I. General information

NPI: 1841181807
Provider Name (Legal Business Name): GRANT ROBERT FODNESS PSY.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46474 252ND ST
COLTON SD
57018-5712
US

IV. Provider business mailing address

800 NE 9TH ST
MADISON SD
57042-1199
US

V. Phone/Fax

Practice location:
  • Phone: 605-446-3538
  • Fax:
Mailing address:
  • Phone: 605-256-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: