Provider Demographics
NPI:1487266722
Name:DAVIS, KATY ANNE
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:ANNE
Other - Last Name:GRACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2430 WOODLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-4200
Mailing Address - Country:US
Mailing Address - Phone:082-496-5763
Mailing Address - Fax:
Practice Address - Street 1:717 N 5TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2048
Practice Address - Country:US
Practice Address - Phone:605-519-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical