MEDICARE: ELIZABETH A KEIZER PIP-LCSW

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	6678	SD

General Provider Information

NPI Number	:	1598590960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A KEIZER PIP-LCSW

Provider Business Mailing Address
First Line	:	3915 FALCON DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9718
Country	:	US
Telephone Number	:	605-381-5741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 W MAIN ST STE 212
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2446
Country	:	US
Telephone Number	:	605-503-1324
Fax Number	:

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

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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