Provider Demographics
NPI:1295708741
Name:SPICERO, CONSTANCE L (EDD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:L
Last Name:SPICERO
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S. MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12200Medicaid
SD680015315OtherRR MEDICARE
SD0040483OtherBLUE CROSS
SD10666OtherMIDLANDS CHOICE
IA1958108Medicaid
NE46022474352Medicaid
MN901553100Medicaid
SDHP41055OtherHEALTHPARTNERS
MN142413OtherUCARE
SD25059OtherARAZ/ AMERICA'S PPO
SDP307OtherDAKOTACARE
MN140M9SPOtherCC SYSTEMS/ BLUE PLUS
OH2633225Medicaid
SD28561OtherSANFORD HEALTH PLAN
SD57108C007OtherWPS TRICARE
SD412991028160OtherPREFERRED ONE
SDHP41055OtherHEALTHPARTNERS
NE46022474352Medicaid
SDS40483Medicare PIN