Provider Demographics
NPI:1912760174
Name:KNEPP, NICHOLE DIANNE (NCC, LPC, SW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:DIANNE
Last Name:KNEPP
Suffix:
Gender:F
Credentials:NCC, LPC, SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 JOLLY LN
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-4763
Mailing Address - Country:US
Mailing Address - Phone:605-343-2811
Mailing Address - Fax:
Practice Address - Street 1:1330 JOLLY LN
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-4763
Practice Address - Country:US
Practice Address - Phone:605-343-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional