Individual
KELLY JOE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSWPIP
Contact information
Practice address
705 E 41ST STREET, SUITE 100, SIOUX FALLS, SD 57105-6047
(605) 357-0121
(605) 357-0190
Mailing address
705 E 41ST STREET, SUITE 100, SIOUX FALLS, SD 57105-6047
(605) 357-0121
(605) 357-0190
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSWPIP1983
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6571380
—
SD
Enumeration date
10/21/2006
Last updated
07/08/2007
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