Provider Demographics
NPI:1457824344
Name:URLACHER, WYATT LAWRENCE (CSW)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:LAWRENCE
Last Name:URLACHER
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1335
Mailing Address - Country:US
Mailing Address - Phone:605-339-0420
Mailing Address - Fax:605-339-0038
Practice Address - Street 1:711 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2203
Practice Address - Country:US
Practice Address - Phone:605-339-0420
Practice Address - Fax:605-339-0038
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4734104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker