Basic Information
| Provider Information | |||||||||
| NPI: | 1720703630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEKKERS | ||||||||
| FirstName: | TERESA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S SYCAMORE AVE STE 105-3 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571101255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053343739 | ||||||||
| FaxNumber: | 6053347752 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 CENTRAL AVE NW STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORANGE CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510411332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127372635 | ||||||||
| FaxNumber: | 7127372344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2022 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 115233 | IA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.