Provider Demographics
NPI:1902099070
Name:FEIOCK, JONATHAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:FEIOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JON
Other - Middle Name:M
Other - Last Name:FEIOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2412 S CLIFF AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4031
Mailing Address - Country:US
Mailing Address - Phone:605-322-4079
Mailing Address - Fax:605-322-4080
Practice Address - Street 1:2412 S CLIFF AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4031
Practice Address - Country:US
Practice Address - Phone:605-322-4079
Practice Address - Fax:605-322-4080
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLCSW 2094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker