Healthcare Provider Details

I. General information

NPI: 1215523097
Provider Name (Legal Business Name): ONDREA KAE PATZLAFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N SYCAMORE AVE
SIOUX FALLS SD
57110-5746
US

IV. Provider business mailing address

801 N SYCAMORE AVE
SIOUX FALLS SD
57110-5746
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-6004
  • Fax: 605-335-2776
Mailing address:
  • Phone: 605-334-6004
  • Fax: 605-335-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4857
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: