Healthcare Provider Details

I. General information

NPI: 1619508116
Provider Name (Legal Business Name): JORDAN JEAN BROCKHOFF MSW, LCSW, ACT, ACT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 S BUR OAK PL
SIOUX FALLS SD
57108-2228
US

IV. Provider business mailing address

5021 S BUR OAK PL
SIOUX FALLS SD
57108-2228
US

V. Phone/Fax

Practice location:
  • Phone: 605-937-6654
  • Fax: 605-937-6749
Mailing address:
  • Phone: 605-937-6654
  • Fax: 605-937-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5012
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: