Provider Demographics
NPI:1083656409
Name:WISNIEWSKI, ROBIN NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:NICOLE
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0387
Mailing Address - Country:US
Mailing Address - Phone:605-721-8822
Mailing Address - Fax:
Practice Address - Street 1:636 SAINT ANNE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4694
Practice Address - Country:US
Practice Address - Phone:605-721-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical