Provider Demographics
NPI:1104423474
Name:JUNG, REBECCA (LCSW, QMHP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:LCSW, QMHP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 N DAKOTA AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6032
Mailing Address - Country:US
Mailing Address - Phone:605-409-3003
Mailing Address - Fax:
Practice Address - Street 1:300 N DAKOTA AVE STE 403
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6032
Practice Address - Country:US
Practice Address - Phone:605-409-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD60511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical