Healthcare Provider Details

I. General information

NPI: 1598590960
Provider Name (Legal Business Name): ELIZABETH A KEIZER PIP-LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W MAIN ST STE 212
RAPID CITY SD
57702-2446
US

IV. Provider business mailing address

3915 FALCON DR
RAPID CITY SD
57701-9718
US

V. Phone/Fax

Practice location:
  • Phone: 605-503-1324
  • Fax:
Mailing address:
  • Phone: 605-381-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6678
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: