Healthcare Provider Details

I. General information

NPI: 1215190715
Provider Name (Legal Business Name): RODNEY DALE VELDHUIZEN D. MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 ELLIOTT RD
CUSTER SD
57730-8239
US

IV. Provider business mailing address

11455 ELLIOTT RD
CUSTER SD
57730-8239
US

V. Phone/Fax

Practice location:
  • Phone: 605-760-3633
  • Fax:
Mailing address:
  • Phone: 605-760-3633
  • Fax: 605-760-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1207
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: