Provider Demographics
NPI:1376836023
Name:MEDEMA, ANDREA KATHERINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:KATHERINE
Last Name:MEDEMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 S KIWANIS AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4200
Mailing Address - Country:US
Mailing Address - Phone:605-323-8001
Mailing Address - Fax:
Practice Address - Street 1:3801 S KIWANIS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4200
Practice Address - Country:US
Practice Address - Phone:605-323-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC7175OtherLPC