Provider Demographics
NPI:1881560050
Name:SANDE RUSSELL, DAVIDA NICOLE SHEREE (LGSW,CSW)
Entity type:Individual
Prefix:
First Name:DAVIDA
Middle Name:NICOLE SHEREE
Last Name:SANDE RUSSELL
Suffix:
Gender:F
Credentials:LGSW,CSW
Other - Prefix:
Other - First Name:DAVIDA
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW,LSW
Mailing Address - Street 1:240 GRANDVIEW AVE W APT 214
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4752
Mailing Address - Country:US
Mailing Address - Phone:605-254-8026
Mailing Address - Fax:
Practice Address - Street 1:705 E 41ST ST STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6048
Practice Address - Country:US
Practice Address - Phone:605-444-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35364104100000X
SD69191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker