Provider Demographics
NPI:1568917243
Name:BRUCKNER, LINDSAY (CSW)
Entity Type:Individual
Prefix:MISS
First Name:LINDSAY
Middle Name:
Last Name:BRUCKNER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 N LINCOLN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-7808
Mailing Address - Country:US
Mailing Address - Phone:605-280-9778
Mailing Address - Fax:
Practice Address - Street 1:1709 N LINCOLN AVE STE 102
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-7808
Practice Address - Country:US
Practice Address - Phone:605-280-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD35981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical