Provider Demographics
NPI:1013254481
Name:MEYER, JERRY J (MSW, LCSW-PIP)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:J
Last Name:MEYER
Suffix:
Gender:M
Credentials:MSW, LCSW-PIP
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:J
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:146 W ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2035
Mailing Address - Country:US
Mailing Address - Phone:605-722-8090
Mailing Address - Fax:605-722-8090
Practice Address - Street 1:146 W ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2035
Practice Address - Country:US
Practice Address - Phone:605-722-8090
Practice Address - Fax:605-722-8090
Is Sole Proprietor?:No
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical