Healthcare Provider Details

I. General information

NPI: 1861323123
Provider Name (Legal Business Name): CYNTHIA JOAN WIXON-LOECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 QUINCY ST
RAPID CITY SD
57701-2813
US

IV. Provider business mailing address

1942 FOX RD APT 103
RAPID CITY SD
57702-2267
US

V. Phone/Fax

Practice location:
  • Phone: 605-391-4863
  • Fax:
Mailing address:
  • Phone: 605-391-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: