Provider Demographics
NPI:1942826631
Name:RINDELAUB, KETTIE ANN (LPC-MH)
Entity Type:Individual
Prefix:
First Name:KETTIE
Middle Name:ANN
Last Name:RINDELAUB
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 KANSAS CITY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3798
Mailing Address - Country:US
Mailing Address - Phone:605-348-6086
Mailing Address - Fax:605-348-1050
Practice Address - Street 1:529 KANSAS CITY ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3798
Practice Address - Country:US
Practice Address - Phone:605-348-6086
Practice Address - Fax:605-348-1050
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health