Provider Demographics
NPI:1851474373
Name:KORKOW, JOHN WILLIAM (CCDC3)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:KORKOW
Suffix:
Gender:M
Credentials:CCDC3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E 41ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6047
Mailing Address - Country:US
Mailing Address - Phone:605-357-0100
Mailing Address - Fax:605-357-0190
Practice Address - Street 1:705 E 41ST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6047
Practice Address - Country:US
Practice Address - Phone:605-357-0100
Practice Address - Fax:605-357-0190
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCCDC3101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor