Healthcare Provider Details

I. General information

NPI: 1316550601
Provider Name (Legal Business Name): JACKSON COLE SCHUMACHER LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 EASTGATE AVE.
PIERRE SD
57501-5691
US

IV. Provider business mailing address

2001 EASTGATE AVE.
PIERRE SD
57501-5691
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5811
  • Fax: 605-224-6921
Mailing address:
  • Phone: 605-224-5811
  • Fax: 605-224-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4996
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: