Provider Demographics
NPI:1902784853
Name:NESSELHUF, STEPHANIE D (ED S)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:NESSELHUF
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13095 MEADOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8517
Mailing Address - Country:US
Mailing Address - Phone:605-553-1064
Mailing Address - Fax:
Practice Address - Street 1:501 DARTMOUTH AVE
Practice Address - Street 2:
Practice Address - City:NEWELL
Practice Address - State:SD
Practice Address - Zip Code:57760-2145
Practice Address - Country:US
Practice Address - Phone:605-456-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool