Provider Demographics
NPI:1700947470
Name:VANKLEY, GALEN R (PHD)
Entity Type:Individual
Prefix:MR
First Name:GALEN
Middle Name:R
Last Name:VANKLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 23RD ST
Mailing Address - Street 2:STE 101 HEARTLAND PSYCHOLOGICAL SERVICES
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:904 W 23RD ST
Practice Address - Street 2:STE 101 HEARTLAND PSYCHOLOGICAL SERVICES
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6551632Medicaid
9171289OtherDAKOTA CARE
4994484OtherBLUE CROSS
2268882OtherCIGNA
269339OtherCOMPSYCH
11823OtherMIDLANDS CHOICE
1998OtherAVERA HEALTH PLAN
SD100471Medicare ID - Type Unspecified