Provider Demographics
NPI:1578669362
Name:ANDAL, KATE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ANDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6581
Mailing Address - Country:US
Mailing Address - Phone:605-312-8700
Mailing Address - Fax:605-312-8701
Practice Address - Street 1:2400 W 49TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-312-8700
Practice Address - Fax:605-312-8701
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8080101Y00000X
SD576103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96097OtherAUXILARY NUMBER