Provider Demographics
NPI:1144376567
Name:HERRBOLDT, TODD WAYNE (CSW-PIP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WAYNE
Last Name:HERRBOLDT
Suffix:
Gender:M
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W BROWN PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6582
Mailing Address - Country:US
Mailing Address - Phone:605-336-1974
Mailing Address - Fax:605-336-9031
Practice Address - Street 1:2210 W BROWN PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6582
Practice Address - Country:US
Practice Address - Phone:605-336-1974
Practice Address - Fax:605-336-9031
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6570570Medicaid
SD6570570Medicaid