Healthcare Provider Details

I. General information

NPI: 1003400193
Provider Name (Legal Business Name): LACEY BALLEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 08/07/2023
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 23RD ST
SIOUX FALLS SD
57105-2108
US

IV. Provider business mailing address

1000 E 23RD ST
SIOUX FALLS SD
57105-2108
US

V. Phone/Fax

Practice location:
  • Phone: 56-322-7549
  • Fax:
Mailing address:
  • Phone: 605-322-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4850
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: