Provider Demographics
NPI:1477687804
Name:RAPP, JONATHAN (LCSW, PIP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:RAPP
Suffix:
Gender:M
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E CABOT ST
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2511
Mailing Address - Country:US
Mailing Address - Phone:605-484-9679
Mailing Address - Fax:
Practice Address - Street 1:820 E CABOT ST
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2511
Practice Address - Country:US
Practice Address - Phone:605-484-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6571170Medicaid