Individual
DR. JOHN ROY SIVESIND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.D
Contact information
Practice address
107 W BROAD AVE, FLANDREAU, SD 57028
(605) 997-2640
Mailing address
107 W BROAD AVE, FLANDREAU, SD 57028
(605) 997-2640
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
283
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5546010
—
SD
Enumeration date
08/09/2007
Last updated
08/09/2007
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