Provider Demographics
NPI:1861543290
Name:RISTY, BRENDA JO (MSW)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JO
Last Name:RISTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LADELLE AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1634
Mailing Address - Country:US
Mailing Address - Phone:605-428-3574
Mailing Address - Fax:
Practice Address - Street 1:2121 W 63RD PL
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5058
Practice Address - Country:US
Practice Address - Phone:605-275-5700
Practice Address - Fax:605-275-5777
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical