Provider Demographics
NPI:1730428095
Name:SCHUPP, KARLA OLDS
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:OLDS
Last Name:SCHUPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:SCHUPP
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:201 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225-1718
Mailing Address - Country:US
Mailing Address - Phone:231-420-0536
Mailing Address - Fax:
Practice Address - Street 1:818 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4861
Practice Address - Country:US
Practice Address - Phone:231-818-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8408163-35011041C0700X
MI8010859011041C0700X
SD49541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical