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NPI Code Detail

MEDICARE: JAMES D KIENITZ MSW

MEDICARE:   JAMES D KIENITZ  MSW
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 Worker407SD

General Provider Information

NPI Number : 1821092818
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES D KIENITZ MSW
Provider Business Mailing Address
First Line : 353 FAIRMONT BLVD
Second Line : ATTEN MEDICAL STAFF SERVICES
City : RAPID CITY
State : SD
Zip : 57701-6000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 890 LAZELLE ST
Second Line :
City : STURGIS
State : SD
Zip : 57785
Country : US
Telephone Number : 605-720-2600
Fax Number : 605-720-2611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 02/05/2013

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