Healthcare Provider Details

I. General information

NPI: 1932079324
Provider Name (Legal Business Name): HANNAH TASTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARBOR DR
SOUTH SIOUX CITY NE
68776-2421
US

IV. Provider business mailing address

3700 28TH ST SPC 156
SIOUX CITY IA
51105-2307
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-3337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number517
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: