Healthcare Provider Details

I. General information

NPI: 1780539486
Provider Name (Legal Business Name): LILA ROSE LEADER CHARGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 S. MAIN STREET.
MISSION SD
57555
US

IV. Provider business mailing address

PO BOX 253
ROSEBUD SD
57570-0253
US

V. Phone/Fax

Practice location:
  • Phone: 605-988-7100
  • Fax:
Mailing address:
  • Phone: 605-988-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6604
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: