Individual
MRS. MARY SUE FONKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.W., L.C.S.W.
Contact information
Practice address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-8225
Mailing address
BOX 133, MOBRIDGE, SD 57601-0133
(605) 845-7938
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1852
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177544
MENTAL HEALTH
SD
01
—
41548
MENTAL HEALTH PROVIDER
SD
01
—
4996672
MENTAL HEALTH PROVIDER
SD
05
—
6570960
—
SD
01
—
96869
MENTAL HEALTH PROVIDER
SD
Enumeration date
10/06/2006
Last updated
07/09/2007
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