Provider Demographics
NPI:1609956283
Name:CARLSEN, JEANNE CAROL (DNP, CNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:CAROL
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:DNP, CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W 41ST ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-8130
Mailing Address - Country:US
Mailing Address - Phone:605-521-0921
Mailing Address - Fax:605-309-7819
Practice Address - Street 1:3101 W 41ST ST STE 209
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-8130
Practice Address - Country:US
Practice Address - Phone:605-521-0921
Practice Address - Fax:605-336-9031
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT1110106H00000X
SDR025116163WP0808X
SDCS004018364SP0807X, 364SP0807X
SDCP001455363LP0808X, 363LP0808X
SDSDCNSCS004018364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575930Medicaid
SD100078Medicare ID - Type Unspecified