Healthcare Provider Details

I. General information

NPI: 1801984026
Provider Name (Legal Business Name): JOSEPHINE A. CHASE MSW, LCSW-PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N 6TH ST.
CUSTER SD
57730
US

IV. Provider business mailing address

15088 220TH ST
BOX ELDER SD
57719-8101
US

V. Phone/Fax

Practice location:
  • Phone: 605-431-1927
  • Fax: 605-923-6466
Mailing address:
  • Phone: 605-923-6466
  • Fax: 605-923-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2103
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6571340
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: