Heather Ann Rystrom, CSW-PIP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3374 Issued in SD

Practice address

2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821

Phone

(605) 385-6700

NPI assigned

May 6, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1740845650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DOOLITTLE DR",
            "city": "ELLSWORTH AFB",
            "state": "SD",
            "postal_code": "577064821",
            "telephone_number": "605-385-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DOOLITTLE DR",
            "city": "ELLSWORTH AFB",
            "state": "SD",
            "postal_code": "577064821",
            "telephone_number": "605-385-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYSTROM",
        "first_name": "HEATHER",
        "middle_name": "ANN",
        "credential": "CSW-PIP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "3374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua R Paull, PA-C
• Diane Ramirez, IDMT
• Jason Razaghi
• Jesse C Roberts, D.D.S.
• Christopher Scott Rohde, MPH, MD
• Carol Rose Sasse, MSW, LCSW-PIP
• Blake Carroll Savage, PHD
• Amy L Schrupp, CSW-PIP, LAC
• Kiersten Severino
• Kimberly Ann Shea

• All providers in Ellsworth Afb, SD
• Clinical Social Worker in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.