Healthcare Provider Details

I. General information

NPI: 1538081815
Provider Name (Legal Business Name): ELENA LEE RADKE-KIESZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 17TH AVE SE APT 104
ABERDEEN SD
57401-7532
US

IV. Provider business mailing address

316 17TH AVE SE APT 104
ABERDEEN SD
57401-7532
US

V. Phone/Fax

Practice location:
  • Phone: 605-228-3574
  • Fax:
Mailing address:
  • Phone: 605-228-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: