Provider Demographics
NPI:1285349795
Name:DRAVLAND, REBECCA P
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:DRAVLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46222 267TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-6724
Mailing Address - Country:US
Mailing Address - Phone:605-431-8856
Mailing Address - Fax:
Practice Address - Street 1:46222 267TH ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-6724
Practice Address - Country:US
Practice Address - Phone:605-431-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7224101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor