Healthcare Provider Details

I. General information

NPI: 1972701266
Provider Name (Legal Business Name): LINDA HOLCOMB,MSW, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CANYON LAKE DR
RAPID CITY SD
57702-3900
US

IV. Provider business mailing address

3601 CANYON LAKE DR
RAPID CITY SD
57702-3900
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-8647
  • Fax: 605-341-0489
Mailing address:
  • Phone: 605-341-8647
  • Fax: 605-341-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-PIP 946
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0004392
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBLUE CROSS/BLUE SHIELD
# 2
Identifier6570532
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MS. LINDA KAY HOLCOMB
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW
Phone: 605-341-8647