Provider Demographics
NPI:1548262157
Name:STOLZ, CAROL (MSW CSW PIP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:STOLZ
Suffix:
Gender:F
Credentials:MSW CSW PIP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:KNABACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW CSW PIP
Mailing Address - Street 1:1410 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-334-2696
Mailing Address - Fax:605-339-9944
Practice Address - Street 1:1410 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-334-2696
Practice Address - Fax:605-339-9944
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1810104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
40683OtherBC/BS
SD6570980Medicaid
P71565Medicare UPIN
40683OtherBC/BS