Provider Demographics
NPI:1538156930
Name:HEDLUND, MINDY G (PHD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:G
Last Name:HEDLUND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 SETTLERS CREEK PL
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-721-7787
Mailing Address - Fax:
Practice Address - Street 1:1818 W FULTON ST
Practice Address - Street 2:STE 101
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4347
Practice Address - Country:US
Practice Address - Phone:605-342-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6551220Medicaid
SD6551220Medicaid