Healthcare Provider Details

I. General information

NPI: 1902784853
Provider Name (Legal Business Name): STEPHANIE D NESSELHUF ED. S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DARTMOUTH AVE
NEWELL SD
57760-2145
US

IV. Provider business mailing address

13095 MEADOWBROOK CT
RAPID CITY SD
57702-8517
US

V. Phone/Fax

Practice location:
  • Phone: 605-456-2393
  • Fax:
Mailing address:
  • Phone: 605-553-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: