Provider Demographics
NPI:1346058617
Name:LOECKER, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LOECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:DYSTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-2141
Mailing Address - Country:US
Mailing Address - Phone:605-553-6654
Mailing Address - Fax:
Practice Address - Street 1:1110 E 77TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3020
Practice Address - Country:US
Practice Address - Phone:605-275-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health