Provider Demographics
NPI:1669778940
Name:MEYER PANKOW, MONICA RAE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:RAE
Last Name:MEYER PANKOW
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RAE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-0126
Mailing Address - Country:US
Mailing Address - Phone:605-698-7688
Mailing Address - Fax:
Practice Address - Street 1:301 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-1901
Practice Address - Country:US
Practice Address - Phone:605-698-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT1217106H00000X
CO985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist