Healthcare Provider Details

I. General information

NPI: 1134849243
Provider Name (Legal Business Name): JAZMIN MENDOZA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SAINT JOSEPH ST STE 201
RAPID CITY SD
57701-3304
US

IV. Provider business mailing address

528 KANSAS CITY ST STE 3
RAPID CITY SD
57701-5037
US

V. Phone/Fax

Practice location:
  • Phone: 605-431-4151
  • Fax: 605-431-4151
Mailing address:
  • Phone: 605-299-9100
  • Fax: 605-250-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

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: