Basic Information
Provider Information
NPI: 1811137961
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KITTAMS-LALLEY
FirstName: JANET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2412 S CLIFF AVE
Address2: SUITE 100
City: SIOUX FALLS
State: SD
PostalCode: 571054031
CountryCode: US
TelephoneNumber: 6053224079
FaxNumber: 6053224080
Practice Location
Address1: 2412 S CLIFF AVE
Address2: SUITE 100
City: SIOUX FALLS
State: SD
PostalCode: 571054031
CountryCode: US
TelephoneNumber: 6053224079
FaxNumber: 6053224080
Other Information
ProviderEnumerationDate: 03/03/2009
LastUpdateDate: 03/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X533SDY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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