Healthcare Provider Details

I. General information

NPI: 1639165152
Provider Name (Legal Business Name): JANETTE THERESA LAPLANTE MS CCDC MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 19TH ST NE
WATERTOWN SD
57201-2823
US

IV. Provider business mailing address

PO BOX 1030
WATERTOWN SD
57201-6030
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-0123
  • Fax: 605-886-5447
Mailing address:
  • Phone: 605-886-0123
  • Fax: 605-886-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5AP546
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: