Healthcare Provider Details

I. General information

NPI: 1962993949
Provider Name (Legal Business Name): RANDALL VETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTH ST
RAPID CITY SD
57701-1163
US

IV. Provider business mailing address

350 ELK ST
RAPID CITY SD
57701-7351
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-0650
  • Fax: 605-342-3692
Mailing address:
  • Phone: 605-343-7262
  • Fax: 605-343-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006928
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: