Provider Demographics
NPI:1477366748
Name:TODD HERRBOLDT LLC
Entity type:Organization
Organization Name:TODD HERRBOLDT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRBOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-PIP
Authorized Official - Phone:605-214-5418
Mailing Address - Street 1:2509 S VILLANOVA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4416
Mailing Address - Country:US
Mailing Address - Phone:605-214-5418
Mailing Address - Fax:
Practice Address - Street 1:2509 S VILLANOVA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4416
Practice Address - Country:US
Practice Address - Phone:605-214-5418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty