Provider Demographics
NPI:1699797795
Name:HAUSHALTER, JUDITH ANN (MSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:HAUSHALTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:MELINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-5432
Mailing Address - Country:US
Mailing Address - Phone:605-336-7939
Mailing Address - Fax:
Practice Address - Street 1:2501 W 22 ST
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117-5046
Practice Address - Country:US
Practice Address - Phone:605-333-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD14841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical