Healthcare Provider Details

I. General information

NPI: 1023756699
Provider Name (Legal Business Name): TAYLER HOOGEVEEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 S BUR OAK PL STE 208
SIOUX FALLS SD
57108-2238
US

IV. Provider business mailing address

5024 S BUR OAK PL STE 208
SIOUX FALLS SD
57108-2238
US

V. Phone/Fax

Practice location:
  • Phone: 507-227-5266
  • Fax:
Mailing address:
  • Phone: 507-227-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TAYLER HOOGEVEEN
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, CSW, QMHP
Phone: 507-227-5266