Provider Demographics
NPI:1316527419
Name:LANDSTROM, EMMA JAYNE (MS)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JAYNE
Last Name:LANDSTROM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 3RD ST SW STE 107
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2432
Mailing Address - Country:US
Mailing Address - Phone:605-412-6446
Mailing Address - Fax:
Practice Address - Street 1:110 3RD ST SW STE 107
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2432
Practice Address - Country:US
Practice Address - Phone:605-412-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health