Provider Demographics
NPI:1437129194
Name:GEDSTAD, KRISTIN L (MED LPC LMFT QMHP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:L
Last Name:GEDSTAD
Suffix:
Gender:F
Credentials:MED LPC LMFT QMHP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:KREIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:SUITE A 922 4TH STREET
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006
Mailing Address - Country:US
Mailing Address - Phone:605-697-6121
Mailing Address - Fax:605-697-6121
Practice Address - Street 1:922 4TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006
Practice Address - Country:US
Practice Address - Phone:605-697-6121
Practice Address - Fax:605-697-6121
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC510101YP2500X
SDQMHP103T00000X
SDLMFT1163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist