Provider Demographics
NPI:1871944868
Name:MOSHER, MANDI (MSW)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-0554
Mailing Address - Country:US
Mailing Address - Phone:605-490-9213
Mailing Address - Fax:605-443-8880
Practice Address - Street 1:761 LAZELLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1608
Practice Address - Country:US
Practice Address - Phone:605-490-9213
Practice Address - Fax:605-443-8880
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical