Provider Demographics
NPI:1811967607
Name:SCOVEL HENDRICKSON, KARI ANN (PHD)
Entity type:Individual
Prefix:MS
First Name:KARI
Middle Name:ANN
Last Name:SCOVEL HENDRICKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:ANN
Other - Last Name:SCOVEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0387
Mailing Address - Country:US
Mailing Address - Phone:605-721-8822
Mailing Address - Fax:605-721-8928
Practice Address - Street 1:2902 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8174
Practice Address - Country:US
Practice Address - Phone:605-721-8822
Practice Address - Fax:605-722-8928
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD439103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2102908OtherCIGNA BEHAVIORAL HEALTH
SD6552060Medicaid
SD6552060Medicaid
SDP85036Medicare UPIN