Healthcare Provider Details

I. General information

NPI: 1548102247
Provider Name (Legal Business Name): MARISSA S WALDNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 N PRESENTATION CT
SIOUX FALLS SD
57104-0768
US

IV. Provider business mailing address

3042 N PRESENTATION CT
SIOUX FALLS SD
57104-0768
US

V. Phone/Fax

Practice location:
  • Phone: 605-214-2908
  • Fax:
Mailing address:
  • Phone: 605-214-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC20904
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: