Healthcare Provider Details

I. General information

NPI: 1306716543
Provider Name (Legal Business Name): JOSIAH ABRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W 41ST ST
SIOUX FALLS SD
57106-6038
US

IV. Provider business mailing address

7220 W 41ST ST
SIOUX FALLS SD
57106-6038
US

V. Phone/Fax

Practice location:
  • Phone: 606-444-9930
  • Fax:
Mailing address:
  • Phone: 606-444-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number164-ABA
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: