Provider Demographics
NPI:1275186520
Name:RIDL, KAYLER (LPC)
Entity Type:Individual
Prefix:
First Name:KAYLER
Middle Name:
Last Name:RIDL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAYLER
Other - Middle Name:GLENN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 E 41ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6048
Mailing Address - Country:US
Mailing Address - Phone:605-444-7528
Mailing Address - Fax:605-444-7690
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:605-444-7528
Practice Address - Fax:605-444-7690
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4965101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health