Healthcare Provider Details

I. General information

NPI: 1760830905
Provider Name (Legal Business Name): MICHELLE SOBERALSKI MSW, LCSW, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W FAIRGROUNDS LOOP # 207
SPEARFISH SD
57783-6051
US

IV. Provider business mailing address

3105 W FAIRGROUNDS LOOP # 207
SPEARFISH SD
57783-6051
US

V. Phone/Fax

Practice location:
  • Phone: 605-923-8150
  • Fax: 605-872-5166
Mailing address:
  • Phone: 605-923-8150
  • Fax: 605-872-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: