Provider Demographics
NPI:1548256050
Name:KRAMLICH, ROBERTA ANN (MA)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:KRAMLICH
Suffix:
Gender:F
Credentials:MA
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 288
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0288
Mailing Address - Country:US
Mailing Address - Phone:605-348-5401
Mailing Address - Fax:605-348-7319
Practice Address - Street 1:528 QUINCY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3628
Practice Address - Country:US
Practice Address - Phone:605-348-5401
Practice Address - Fax:605-348-7319
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD216103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6550980Medicaid
SDS02992Medicare UPIN
SD4061Medicare ID - Type Unspecified