Healthcare Provider Details

I. General information

NPI: 1184117871
Provider Name (Legal Business Name): RACHEL THYBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 08/04/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 69TH ST
SIOUX FALLS SD
57108-8321
US

IV. Provider business mailing address

1601 E 69TH ST STE 307
SIOUX FALLS SD
57108-8322
US

V. Phone/Fax

Practice location:
  • Phone: 605-202-5870
  • Fax:
Mailing address:
  • Phone: 605-202-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091024
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5133
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: