Healthcare Provider Details

I. General information

NPI: 1730530593
Provider Name (Legal Business Name): JAYNE RUBENDALL ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N CAPITAL ST
MITCHELL SD
57301-1152
US

IV. Provider business mailing address

1421 N CAPITAL ST
MITCHELL SD
57301-1152
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-4634
  • Fax:
Mailing address:
  • Phone: 605-996-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number62759-1
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: