Individual
WAMBLI BEAR RUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4854
SD
Other
Enumeration date
04/11/2025
Last updated
04/11/2025
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