MEDICARE: JOE TOLSON 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	1737	SD

General Provider Information

NPI Number	:	1710961693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE TOLSON LCSW

Provider Business Mailing Address
First Line	:	907 COLUMBUS ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3542
Country	:	US
Telephone Number	:	605-341-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 COLUMBUS ST
Second Line	:	ORTHODOX DIOCESAN SERVICES
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3542
Country	:	US
Telephone Number	:	605-341-2404
Fax Number	:

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

Provider Enumeration Date	:	12/03/2005
Last Update Date	:	07/08/2007

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