Healthcare Provider Details

I. General information

NPI: 1255757910
Provider Name (Legal Business Name): KAYLEE TROTTIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 JORDAN DR
RAPID CITY SD
57702-8738
US

IV. Provider business mailing address

624 NORTHERN LIGHTS BLVD
BOX ELDER SD
57719-4305
US

V. Phone/Fax

Practice location:
  • Phone: 605-791-7414
  • Fax:
Mailing address:
  • Phone: 605-431-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number522-PROV
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier522-PROV
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSOUTH DAKOTA LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: