1437129194 NPI number — MS. KRISTIN L GEDSTAD MED LPC LMFT QMHP

Table of content: MS. KRISTIN L GEDSTAD MED LPC LMFT QMHP (NPI 1437129194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437129194 NPI number — MS. KRISTIN L GEDSTAD MED LPC LMFT QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEDSTAD
Provider First Name:
KRISTIN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED LPC LMFT QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KREIDER
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437129194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 82
Provider Second Line Business Mailing Address:
SUITE A 922 4TH STREET
Provider Business Mailing Address City Name:
BROOKINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-697-6121
Provider Business Mailing Address Fax Number:
605-697-6121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-697-6121
Provider Business Practice Location Address Fax Number:
605-697-6121
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC510 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , with the licence number: QMHP , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT1163 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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