Provider Demographics
NPI:1447201306
Name:TRUCANO, TERRY L (CSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:TRUCANO
Suffix:
Gender:F
Credentials:CSW
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 3450
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3450
Mailing Address - Country:US
Mailing Address - Phone:605-347-3616
Mailing Address - Fax:605-347-4713
Practice Address - Street 1:890 LAZELLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1611
Practice Address - Country:US
Practice Address - Phone:605-347-3616
Practice Address - Fax:605-347-4713
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD826104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6570345Medicaid
SD4994246OtherWELLMARK
SD6570345Medicaid