Healthcare Provider Details

I. General information

NPI: 1114695806
Provider Name (Legal Business Name): DIANA SMALLWOOD LCSW-PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA KAUTZ

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BURLEIGH ST
YANKTON SD
57078-2418
US

IV. Provider business mailing address

1700 BURLEIGH ST
YANKTON SD
57078-2418
US

V. Phone/Fax

Practice location:
  • Phone: 605-260-9284
  • Fax: 605-260-9284
Mailing address:
  • Phone: 605-260-9284
  • Fax: 605-665-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6028
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6673
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: