Provider Demographics
NPI:1104892785
Name:LEIR, EILEEN SPELLACY (CSW-PIP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:SPELLACY
Last Name:LEIR
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9462
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-9462
Mailing Address - Country:US
Mailing Address - Phone:605-342-0504
Mailing Address - Fax:605-348-0919
Practice Address - Street 1:24 EAST NEW YORK
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2441
Practice Address - Country:US
Practice Address - Phone:605-342-0504
Practice Address - Fax:605-348-0919
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD18061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9233748OtherDAKOTA CARE
SD6571040Medicaid
SD4995473OtherBLUE CROSS/BLE SHIELD
SD6571040Medicaid