Organization
SUSAN K ELEESON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN KRISTINE ELEESON PH.D. (CEO/LICENSED PSYCHOLOGIST)
(605) 351-5826
Entity
Organization
Contact information
Practice address
47143 299TH ST, BERESFORD, SD 57004
(605) 351-5826
Mailing address
47143 299TH ST., BERESFORD, SD 57004
(605) 351-5826
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
399
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568417657
—
SD
01
—
S107742
PTAN
SD
Enumeration date
10/01/2015
Last updated
02/01/2024
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