Basic Information
| Provider Information | |||||||||
| NPI: | 1811127822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMLE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ALINE | ||||||||
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| Credential: | L.I.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2007 BUTTE VIEW DR | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577851706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015350616 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 949 HARMON ST | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883656271 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2009 | ||||||||
| LastUpdateDate: | 09/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18243 | MN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 4297 | ND | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 4952 | SD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 4952 | 01 | SD | LICENSE | OTHER |