Provider Demographics
NPI:1538735857
Name:KENNY POSPISCHIL
Entity type:Organization
Organization Name:KENNY POSPISCHIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-521-9671
Mailing Address - Street 1:5000 S MAC ARTHUR LN STE 104
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5407
Mailing Address - Country:US
Mailing Address - Phone:605-202-8283
Mailing Address - Fax:605-202-8130
Practice Address - Street 1:5000 S MAC ARTHUR LN STE 104
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5407
Practice Address - Country:US
Practice Address - Phone:605-202-8283
Practice Address - Fax:605-202-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC20303OtherSD LPC LICENSE
MNCC02638OtherMN LPCC