Provider Demographics
NPI:1750145439
Name:HEDEEN, KINDRA (LMT)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:
Last Name:HEDEEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 E ROSA PARKS PL STE 201
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-3122
Mailing Address - Country:US
Mailing Address - Phone:605-518-9408
Mailing Address - Fax:
Practice Address - Street 1:5010 E ROSA PARKS PL
Practice Address - Street 2:SUITE 201B
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110
Practice Address - Country:US
Practice Address - Phone:605-518-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist