Healthcare Provider Details

I. General information

NPI: 1437142288
Provider Name (Legal Business Name): MARY J EGGLESTON MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 S BROWN PL
SIOUX FALLS SD
57105-6582
US

IV. Provider business mailing address

2210 S BROWN PL
SIOUX FALLS SD
57105-6582
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-1700
  • Fax: 605-336-9031
Mailing address:
  • Phone: 605-332-1700
  • Fax: 605-336-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 537
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1015
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: