Healthcare Provider Details

I. General information

NPI: 1861119562
Provider Name (Legal Business Name): HANNAH KATHERINE WIEDEBUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S MAIN ST STE 1E
ABERDEEN SD
57401-4189
US

IV. Provider business mailing address

14 S MAIN ST STE 1E
ABERDEEN SD
57401-4189
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-1010
  • Fax: 605-725-8055
Mailing address:
  • Phone: 605-225-1010
  • Fax: 605-725-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC21013
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: