Provider Demographics
NPI:1063940427
Name:LAVONNE APPLETOFT, LLC
Entity type:Organization
Organization Name:LAVONNE APPLETOFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLETOFT
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, LSW, LPC-MH
Authorized Official - Phone:605-225-3622
Mailing Address - Street 1:405 8TH AVE NW STE 333
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2700
Mailing Address - Country:US
Mailing Address - Phone:605-225-3622
Mailing Address - Fax:605-229-2719
Practice Address - Street 1:405 8TH AVE NW STE 333
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2700
Practice Address - Country:US
Practice Address - Phone:605-225-3622
Practice Address - Fax:605-229-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLSW805104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575712Medicaid