Provider Demographics
NPI:1578709465
Name:RED BOW, STARDUST H (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:STARDUST
Middle Name:H
Last Name:RED BOW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COMANCHE RD
Mailing Address - Street 2:FM-116
Mailing Address - City:FORT MEADE
Mailing Address - State:SD
Mailing Address - Zip Code:57741
Mailing Address - Country:US
Mailing Address - Phone:605-490-9704
Mailing Address - Fax:
Practice Address - Street 1:113 COMANCHE RD
Practice Address - Street 2:FM-116
Practice Address - City:FORT MEADE
Practice Address - State:SD
Practice Address - Zip Code:57741
Practice Address - Country:US
Practice Address - Phone:605-490-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13045782-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical