Provider Demographics
NPI:1114695806
Name:SMALLWOOD, DIANA (LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:KAUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3516
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:614 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3516
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6028104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker