MEDICARE: MINDY G HEDLUND PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	362	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538156930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY G HEDLUND PHD

Provider Business Mailing Address
First Line	:	1219 SETTLERS CREEK PL
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701
Country	:	US
Telephone Number	:	605-721-7787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 W FULTON ST
Second Line	:	STE 101
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4347
Country	:	US
Telephone Number	:	605-342-5238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/25/2022

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