Healthcare Provider Details

I. General information

NPI: 1073695334
Provider Name (Legal Business Name): ENEMY SWIM DAY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 446TH AVE
WAUBAY SD
57273-5715
US

IV. Provider business mailing address

13525 446TH AVE
WAUBAY SD
57273-5715
US

V. Phone/Fax

Practice location:
  • Phone: 606-947-4605
  • Fax: 605-947-4188
Mailing address:
  • Phone: 606-947-4605
  • Fax: 605-947-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHERRY ANN JOHNSON
Title or Position: SUPERINTENDENT
Credential: ED.D
Phone: 605-947-4605