Provider Demographics
NPI:1134849243
Name:MENDOZA, JAZMIN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 KANSAS CITY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5037
Mailing Address - Country:US
Mailing Address - Phone:605-299-9100
Mailing Address - Fax:605-250-5159
Practice Address - Street 1:909 SAINT JOSEPH ST STE 201
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3304
Practice Address - Country:US
Practice Address - Phone:605-431-4151
Practice Address - Fax:605-431-4151
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical