Provider Demographics
NPI:1689801896
Name:SDSU STUDENT HEALTH CLINIC
Entity Type:Organization
Organization Name:SDSU STUDENT HEALTH CLINIC
Other - Org Name:BROOKINGS FAMILY PLANNING CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-688-4157
Mailing Address - Street 1:N. CAMPUS DRIVE
Mailing Address - Street 2:WELLNESS CENTER, BOX 2818
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57007
Mailing Address - Country:US
Mailing Address - Phone:605-688-4157
Mailing Address - Fax:
Practice Address - Street 1:N. CAMPUS DRIVE
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57007
Practice Address - Country:US
Practice Address - Phone:605-688-4157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SDSU STUDENT HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical