Healthcare Provider Details

I. General information

NPI: 1639084130
Provider Name (Legal Business Name): NICOLE D ROBECK MSW,MA,LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 KANSAS CITY ST
RAPID CITY SD
57701-3079
US

IV. Provider business mailing address

5856 DERRINGER RD
RAPID CITY SD
57703-9054
US

V. Phone/Fax

Practice location:
  • Phone: 605-472-8411
  • Fax:
Mailing address:
  • Phone: 605-484-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24102019
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: