Healthcare Provider Details

I. General information

NPI: 1194049882
Provider Name (Legal Business Name): REBECCA J KUCH MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 8TH AVE NE STE 135
ABERDEEN SD
57401-3254
US

IV. Provider business mailing address

634 S ROOSEVELT ST STE 4
ABERDEEN SD
57401-6593
US

V. Phone/Fax

Practice location:
  • Phone: 605-228-4664
  • Fax:
Mailing address:
  • Phone: 605-228-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH2194
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MH2194
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: