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505 W 9th St Ste 203 Sioux Falls SD 57104-3667 | |
| (605) 202-5027 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 505 W 9th St Ste 203, Sioux Falls, South Dakota |
| Authorized Official Name and Position | Jordan Jean Brockhoff (OWNER/PROVIDER) |
| Authorized Official Contact | 6052025027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
505 W 9th St Ste 203 Sioux Falls SD 57104-3667 Ph: (605) 202-5027 | 505 W 9th St Ste 203 Sioux Falls SD 57104-3667 Ph: (605) 202-5027 |
| NPI Number | 1538930011 |
|---|---|
| Provider Enumeration Date | 01/12/2024 |
| Last Update Date | 03/19/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 2163869363 |
|---|---|
| Medicare Enrollment ID | O20240324000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538930011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jordan J Brockhoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619508116 PECOS PAC ID: 9234547712 Enrollment ID: I20210422000192 |
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