Provider Demographics
NPI:1740575240
Name:NELSON, JERI LYNN (CSW-PIP)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:ATTN: P.F.S. PROV ENROLLMENT
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-6400
Mailing Address - Fax:
Practice Address - Street 1:2412 S CLIFF AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4031
Practice Address - Country:US
Practice Address - Phone:605-322-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD15131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740575240OtherBCBS MN
SD2002867Medicaid
IA1740575240Medicaid
1740575240OtherDAKOTACARE
1740575240OtherWELLMARK BCBS/TRICARE
MN1740575240Medicaid
SDS105091Medicare PIN