Provider Demographics
NPI:1801984026
Name:CHASE, JOSEPHINE A (MSW, LCSW-PIP)
Entity type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:A
Last Name:CHASE
Suffix:
Gender:F
Credentials:MSW, LCSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15088 220TH ST
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-8101
Mailing Address - Country:US
Mailing Address - Phone:605-923-6466
Mailing Address - Fax:605-923-6466
Practice Address - Street 1:29 N 6TH ST.
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730
Practice Address - Country:US
Practice Address - Phone:605-431-1927
Practice Address - Fax:605-923-6466
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD21031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6571340Medicaid
SD100892Medicare ID - Type UnspecifiedPROVIDER ID NUMBER