Provider Demographics
NPI:1023237831
Name:ROSE, DANIALLE DIANE (LCSW-PIP, QMHP, LADC)
Entity type:Individual
Prefix:
First Name:DANIALLE
Middle Name:DIANE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW-PIP, QMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 ALBANY AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-2100
Mailing Address - Country:US
Mailing Address - Phone:605-745-5251
Mailing Address - Fax:605-745-6813
Practice Address - Street 1:1738 ALBANY AVE
Practice Address - Street 2:STE 2
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2100
Practice Address - Country:US
Practice Address - Phone:605-745-5251
Practice Address - Fax:605-745-6813
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD21674OtherSIOUX VALLEY HEALTH CARE
SD2009923Medicaid
SDS111078Medicare PIN