Provider Demographics
NPI:1710680541
Name:RADKE, AMY DIANE (CSW, MSW-PIP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:RADKE
Suffix:
Gender:F
Credentials:CSW, MSW-PIP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DIANE
Other - Last Name:STENSLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5020 S BROADBAND LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2318
Mailing Address - Country:US
Mailing Address - Phone:605-330-4552
Mailing Address - Fax:
Practice Address - Street 1:5020 S BROADBAND LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2318
Practice Address - Country:US
Practice Address - Phone:605-330-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD61231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical