MEDICARE: KATHERINE WOUDSTRA PSY.D., LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1265128508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE WOUDSTRA PSY.D., LP

Provider Business Mailing Address
First Line	:	3100 S GROVELAND DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-6000
Country	:	US
Telephone Number	:	954-707-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 E 69TH ST STE A
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8331
Country	:	US
Telephone Number	:	605-275-2280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	05/26/2026

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