Healthcare Provider Details

I. General information

NPI: 1114298247
Provider Name (Legal Business Name): MRS. CONSTANCE ELISE KOLBREK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONNIE ELISE KOLBREK LPC

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S LYNCREST PL STE 105
SIOUX FALLS SD
57108-2574
US

IV. Provider business mailing address

1101 E LIBBY LN
SIOUX FALLS SD
57108-4667
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-1516
  • Fax: 605-731-0896
Mailing address:
  • Phone: 605-254-5525
  • Fax: 605-977-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLPC984
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC984
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: