Provider Demographics
NPI:1447222997
Name:GRABER, CONNIE DENISE (PSYD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:DENISE
Last Name:GRABER
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 1:4400 W 69TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8171
Mailing Address - Country:US
Mailing Address - Phone:605-322-7580
Mailing Address - Fax:605-322-7579
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-7580
Practice Address - Fax:605-322-7579
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1402466OtherARAZ/ AMERICA'S PPO
SD57108D007OtherWPS TRICARE
SD769191028797OtherPREFERRED ONE
SDHP35188OtherHEALTHPARTNERS
ND12242Medicaid
SD25924OtherSANFORD HEALTH PLAN
NE46022474340Medicaid
SD231488OtherMIDLANDS CHOICE
SD680014064OtherRR MEDICARE
SD6551770Medicaid
MN40M62SWOtherCC SYSTEMS/ BLUE PLUS
SDP396OtherDAKOTACARE
MN151769OtherUCARE
IA3148379Medicaid
MN744420600Medicaid
SD0008183OtherBLUE CROSS
MN92411422904OtherPRIMEWEST
MN40M62SWOtherCC SYSTEMS/ BLUE PLUS
SDS8183Medicare PIN