Individual
SHIRLEY B ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4110 WINFIELD CT, RAPID CITY, SD 57701-8306
(605) 415-0792
Mailing address
2734 EDEN LN, RAPID CITY, SD 57703-6036
(605) 415-0792
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-2789782
DEPTPARTMENT OF TREASURY
SD
01
—
DL137092
SOUTH DAKOTA SECRETARY OF STATE
SD
Enumeration date
10/04/2017
Last updated
06/16/2018
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