Provider Demographics
NPI:1952301970
Name:VANSTEENWYK, LAURA JO (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JO
Last Name:VANSTEENWYK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 W 25TH ST
Mailing Address - Street 2:ATTN SIOUX FALLS PSYCHOLOGICAL SERVICES
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-334-2696
Mailing Address - Fax:605-339-9944
Practice Address - Street 1:1410 W 25TH ST
Practice Address - Street 2:ATTN SIOUX FALLS PSYCHOLOGICAL SERVICES
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-334-2696
Practice Address - Fax:605-339-9944
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMSW CSW-PIP 1891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4994977OtherBC BS
SD6570952Medicaid