Provider Demographics
NPI:1346262649
Name:SAZAMA, KATHY J (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:J
Last Name:SAZAMA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 S EUCLID AVE
Mailing Address - Street 2:SUITE 201 MBII
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-7700
Mailing Address - Country:US
Mailing Address - Phone:605-328-7590
Mailing Address - Fax:605-328-7596
Practice Address - Street 1:1201 S EUCLID AVE
Practice Address - Street 2:SUITE 201 MBII
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-7700
Practice Address - Country:US
Practice Address - Phone:605-328-7590
Practice Address - Fax:605-328-7596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SDSDLMFT 1000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995878OtherBLUE CROSS BLUE SHEILD
MN8G720SAOtherBLUE CROSS BLUE SHEILD
SD22400OtherSIOUX VALLEY HEALTH PLAN
IL123724OtherCOMPSYCH