Healthcare Provider Details

I. General information

NPI: 1407403777
Provider Name (Legal Business Name): CELESTE MICHELE UTHE-BUROW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W GLEN EAGLE CIR
SIOUX FALLS SD
57108-4122
US

IV. Provider business mailing address

1108 W GLEN EAGLE CIR
SIOUX FALLS SD
57108-4122
US

V. Phone/Fax

Practice location:
  • Phone: 605-201-0104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CELESTE MICHELE UTHE-BUROW
Title or Position: OWNER & PROVIDER
Credential:
Phone: 605-201-0104