Provider Demographics
NPI:1497031371
Name:VANDER WOUDE, CHRISTINA RENEE (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENEE
Last Name:VANDER WOUDE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N DULUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104
Mailing Address - Country:US
Mailing Address - Phone:605-988-3775
Mailing Address - Fax:605-988-3747
Practice Address - Street 1:523 N DULUTH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2714
Practice Address - Country:US
Practice Address - Phone:605-988-3775
Practice Address - Fax:605-988-3747
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2295-SW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker