Healthcare Provider Details

I. General information

NPI: 1215785548
Provider Name (Legal Business Name): JESSICA J NELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 E 57TH ST
SIOUX FALLS SD
57108-8818
US

IV. Provider business mailing address

PO BOX 2
INWOOD IA
51240-0002
US

V. Phone/Fax

Practice location:
  • Phone: 605-306-3240
  • Fax:
Mailing address:
  • Phone: 605-595-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123914
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6587
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: