Provider Demographics
NPI:1972231751
Name:THALER, TORI SARAH (LCSW-PIP, LISW)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:SARAH
Last Name:THALER
Suffix:
Gender:F
Credentials:LCSW-PIP, LISW
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:SARAH
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-9675
Mailing Address - Country:US
Mailing Address - Phone:605-384-3418
Mailing Address - Fax:
Practice Address - Street 1:513 3RD ST SW
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-9675
Practice Address - Country:US
Practice Address - Phone:605-384-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1001801041C0700X, 104100000X
SD5190104100000X
SD63081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker