Provider Demographics
NPI:1801413216
Name:STECKLER, TANNER J
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:J
Last Name:STECKLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S MAIN ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4189
Mailing Address - Country:US
Mailing Address - Phone:605-725-4956
Mailing Address - Fax:
Practice Address - Street 1:14 S MAIN ST STE 1E
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4189
Practice Address - Country:US
Practice Address - Phone:605-725-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD63071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical