Provider Demographics
NPI:1548979115
Name:MAKI, KARLIE RENAE (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:KARLIE
Middle Name:RENAE
Last Name:MAKI
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:MISS
Other - First Name:KARLIE
Other - Middle Name:RENAE
Other - Last Name:WARNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S SPLITROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1652
Mailing Address - Country:US
Mailing Address - Phone:605-582-2049
Mailing Address - Fax:
Practice Address - Street 1:300 S SPLITROCK BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1652
Practice Address - Country:US
Practice Address - Phone:605-582-2049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD86219103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool