Healthcare Provider Details

I. General information

NPI: 1194516500
Provider Name (Legal Business Name): CUSTER SCHOOL DISTRICT 16-1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WILD CAT LN
CUSTER SD
57730-2478
US

IV. Provider business mailing address

527 MONTGOMERY ST
CUSTER SD
57730-1124
US

V. Phone/Fax

Practice location:
  • Phone: 605-673-4483
  • Fax:
Mailing address:
  • Phone: 605-673-2171
  • 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: KATHERINE JENSEN
Title or Position: SPECIAL EDUCATION EVALUATOR
Credential: ED.S
Phone: 605-673-2172