Healthcare Provider Details

I. General information

NPI: 1437129194
Provider Name (Legal Business Name): KRISTIN L GEDSTAD MED LPC LMFT QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KRISTIN L KREIDER

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 4TH STREET SUITE A
BROOKINGS SD
57006
US

IV. Provider business mailing address

PO BOX 82 SUITE A 922 4TH STREET
BROOKINGS SD
57006
US

V. Phone/Fax

Practice location:
  • Phone: 605-697-6121
  • Fax: 605-697-6121
Mailing address:
  • Phone: 605-697-6121
  • Fax: 605-697-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC510
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberQMHP
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1163
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: