Provider Demographics
NPI:1588639009
Name:VAN GILDER-PIERCE, TARYN SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TARYN
Middle Name:SUE
Last Name:VAN GILDER-PIERCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-665-0258
Mailing Address - Fax:
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3730
Practice Address - Country:US
Practice Address - Phone:605-665-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE411967561-00Medicaid
SD6551830Medicaid
8050Medicare ID - Type Unspecified