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Individual

JENNIFER GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
12057 411TH AVE, CLAREMONT, SD 57432-7302
(605) 290-1163
Mailing address
12057 411TH AVE, CLAREMONT, SD 57432-7302
(605) 290-1163

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0487
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1041741
CERTIFICATION
SD
Enumeration date
11/10/2008
Last updated
01/12/2022
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