Provider Demographics
NPI:1518953405
Name:SPERLE, CLINT JAMES (MA)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:JAMES
Last Name:SPERLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 S CARNEGIE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2360
Mailing Address - Country:US
Mailing Address - Phone:605-323-2345
Mailing Address - Fax:605-323-2822
Practice Address - Street 1:4105 S CARNEGIE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2360
Practice Address - Country:US
Practice Address - Phone:605-323-2345
Practice Address - Fax:605-323-2822
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2089101YM0800X
SDLPC985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575600Medicaid