Healthcare Provider Details

I. General information

NPI: 1891728986
Provider Name (Legal Business Name): JUDY RENEE DE WIT MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S PHILLIPS AVE STE 121
SIOUX FALLS SD
57105-6864
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW SUITE110
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 605-359-0034
  • Fax:
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1227
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: