Healthcare Provider Details

I. General information

NPI: 1811230998
Provider Name (Legal Business Name): JANET MARIE LASSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 06/02/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12451 HWY 1806 N
MOBRIDGE SD
57601-5760
US

IV. Provider business mailing address

151 W BRUNDAGE ST
SHERIDAN WY
82801-4217
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-7181
  • Fax: 605-845-5072
Mailing address:
  • Phone: 307-674-1668
  • Fax: 307-674-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-830
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: