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General NPI Number Information
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NPI Number | 1043115280
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Entity Type | Organization
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Legal Business Name | HUMAN SERVICE AGENCY
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 123 19TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-2823
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Country | US
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Telephone | 605-886-0123
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Fax | 605-886-5447
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Provider Business Mailing Address
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Address Line | 123 19TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-2823
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Country | US
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Telephone | 605-886-0123
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Fax | 605-886-5447
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Authorized Official
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Title or Position | ACCOUNT SPECIALIST
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Name | KENDRA WILDBERGER
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Credential |
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Telephone | 605-884-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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