Provider Demographics
NPI:1144797804
Name:DYKSTRA, SARAH JO (MSW-PIP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:MSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 4TH ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1898
Mailing Address - Country:US
Mailing Address - Phone:605-886-5262
Mailing Address - Fax:605-886-5228
Practice Address - Street 1:600 4TH ST NE STE 203
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1898
Practice Address - Country:US
Practice Address - Phone:605-886-5262
Practice Address - Fax:605-886-5228
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical