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General NPI Number Information
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NPI Number | 1396299764
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Entity Type | Individual
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Provider Name | BROCK SEEFELDT C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 400 CUNNINGHAM WAY BUILDING 1
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City | DANVILLE
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State | KY
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Zip | 40422-8339
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Country | US
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Telephone | 859-936-3537
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 W 22ND ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1521
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Country | US
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Telephone | 605-312-1000
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Fax | 605-312-1001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 252059
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | SD
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