MEDICARE: DANIALLE DIANE ROSE LCSW-PIP, QMHP, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21674	OTHER	SD	SIOUX VALLEY HEALTH CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023237831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIALLE DIANE ROSE LCSW-PIP, QMHP, LADC

Provider Business Mailing Address
First Line	:	1738 ALBANY AVE
Second Line	:	STE 2
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2100
Country	:	US
Telephone Number	:	605-745-5251
Fax Number	:	605-745-6813

Provider Business Practice Location Address
First Line	:	1738 ALBANY AVE
Second Line	:	STE 2
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2100
Country	:	US
Telephone Number	:	605-745-5251
Fax Number	:	605-745-6813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	09/19/2016

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