Healthcare Provider Details

I. General information

NPI: 1437068889
Provider Name (Legal Business Name): MRS. BOBBI JEAN LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BOBBI J SMITH

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45974 232ND ST
WENTWORTH SD
57075-6932
US

IV. Provider business mailing address

45974 232ND ST
WENTWORTH SD
57075-6932
US

V. Phone/Fax

Practice location:
  • Phone: 605-270-2711
  • Fax:
Mailing address:
  • Phone: 605-270-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT11903
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: