Provider Demographics
NPI:1134849029
Name:WOLLES, RILEY (LCSW, QMHP)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:WOLLES
Suffix:
Gender:F
Credentials:LCSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2835
Mailing Address - Country:US
Mailing Address - Phone:605-322-3601
Mailing Address - Fax:605-322-5479
Practice Address - Street 1:2020 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2835
Practice Address - Country:US
Practice Address - Phone:605-322-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD62381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical