Provider Demographics
NPI:1821060302
Name:VANDE WEERD, LINDA K
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:K
Last Name:VANDE WEERD
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 1:922 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2173
Mailing Address - Country:US
Mailing Address - Phone:605-692-6444
Mailing Address - Fax:605-692-8997
Practice Address - Street 1:922 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2173
Practice Address - Country:US
Practice Address - Phone:605-692-6444
Practice Address - Fax:605-692-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9804992101YA0400X
SDLPC MH 2040101YP2500X
LMFT 1137106H00000X
SDRO15085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4997874OtherBCBS
SD6575272Medicaid
SD6575272Medicaid