Healthcare Provider Details

I. General information

NPI: 1164027397
Provider Name (Legal Business Name): DANICA ZOMER MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W. STATE ST.
PLANKINTON SD
57368
US

IV. Provider business mailing address

27442 391ST AVE
CORSICA SD
57328-5421
US

V. Phone/Fax

Practice location:
  • Phone: 605-942-7332
  • Fax:
Mailing address:
  • Phone: 605-680-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4834
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: