Healthcare Provider Details

I. General information

NPI: 1578674099
Provider Name (Legal Business Name): CHRISTEL LYNN KITZELMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 MOON MEADOWS DR APT 427
RAPID CITY SD
57702-8564
US

IV. Provider business mailing address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

V. Phone/Fax

Practice location:
  • Phone: 605-718-1095
  • Fax: 605-718-1094
Mailing address:
  • Phone: 605-347-2511
  • Fax: 605-718-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1508
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: