Provider Demographics
NPI:1841762754
Name:SOUTHWEST MINNESOTA STATE UNIVERSITY STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:SOUTHWEST MINNESOTA STATE UNIVERSITY STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, PHN
Authorized Official - Phone:507-537-7202
Mailing Address - Street 1:1501 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3306
Mailing Address - Country:US
Mailing Address - Phone:507-537-7202
Mailing Address - Fax:507-537-7259
Practice Address - Street 1:1501 STATE ST # BA158
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3306
Practice Address - Country:US
Practice Address - Phone:507-537-7202
Practice Address - Fax:507-537-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health