MEDICARE: MRS. KATIE BRUNICK MSW, 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
1	101YM0800X	Mental Health Counselor	6101	SD

General Provider Information

NPI Number	:	1720959141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE BRUNICK MSW, LCSW, QMHP

Provider Business Mailing Address
First Line	:	43383 310TH ST
Second Line	:
City	:	YANKTON
State	:	SD
Zip	:	57078-6225
Country	:	US
Telephone Number	:	605-369-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 WOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	SD
Zip	:	57062-2238
Country	:	US
Telephone Number	:	605-369-2201
Fax Number	:

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

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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