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NPI Code Detail

MEDICARE: REBECCA JUNG LCSW, QMHP

MEDICARE: REBECCA JUNG LCSW, QMHP
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
11041C0700XClinical Social Worker6051SD

General Provider Information

NPI Number : 1104423474
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA JUNG LCSW, QMHP
Provider Business Mailing Address
First Line : 300 N DAKOTA AVE STE 403
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-6032
Country : US
Telephone Number : 605-409-3003
Fax Number :
Provider Business Practice Location Address
First Line : 300 N DAKOTA AVE STE 403
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-6032
Country : US
Telephone Number : 605-409-3003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2020
Last Update Date : 09/05/2023

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