Provider Demographics
NPI:1467520148
Name:FJELLAND, MARLIN T (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARLIN
Middle Name:T
Last Name:FJELLAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2615
Mailing Address - Country:US
Mailing Address - Phone:605-225-1010
Mailing Address - Fax:605-725-8057
Practice Address - Street 1:628 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2615
Practice Address - Country:US
Practice Address - Phone:605-225-1010
Practice Address - Fax:605-725-8057
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLCSW1911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6571270Medicaid
SD6571272Medicaid
SD101015Medicare PIN
SD90533Medicare PIN