| Dr.jackiegilbertsonllc | |
|
623 Quincy St 102 Rapid City SD 57701-8231 | |
| (605) 430-6364 | |
| (605) 716-9491 |
| Full Name | Dr.jackiegilbertsonllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 623 Quincy St, Rapid City, South Dakota |
| Authorized Official Name and Position | Jackie R Gilbertson (PSYCHOLOGISTLICENSED) |
| Authorized Official Contact | 6054306364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr.jackiegilbertsonllc 623 Quincy St 102 Rapid City SD 57701-8231 Ph: (605) 430-6364 | Dr.jackiegilbertsonllc 623 Quincy St 102 Rapid City SD 57701-8231 Ph: (605) 430-6364 |
| NPI Number | 1124383435 |
|---|---|
| Provider Enumeration Date | 07/12/2012 |
| Last Update Date | 07/12/2012 |
| Medicare PECOS PAC ID | 3476701749 |
|---|---|
| Medicare Enrollment ID | O20120911000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124383435 | NPI | - | NPPES |
| 6551113 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 276 (South Dakota) | Primary |
| Provider Name | Jackie R Gilbertson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952380289 PECOS PAC ID: 7911908736 Enrollment ID: I20070122000640 |
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