Individual
MARY E KURNIAWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
915 MT VIEW RD, RAPID CITY, SD 57702-3414
(605) 755-7300
(605) 755-0707
Mailing address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 755-8110
(605) 755-0707
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3497
SD
Other
Enumeration date
01/31/2017
Last updated
04/24/2017
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