Individual
KATIE NICOLE WIECZOREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-MH, QMHP
Contact information
Practice address
712 S SANBORN BLVD STE 9, MITCHELL, SD 57301-3902
(605) 674-3797
Mailing address
712 S SANBORN BLVD, STE 9 PMB#6143, MITCHELL, SD 57301-3902
(605) 674-3797
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
20535
SD
101Y00000X
Counselor
Primary
30826
SD
101YM0800X
Mental Health Counselor
QMHP
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20535
STATE LICENSE - LPC
SD
01
—
30826
LPC-MH
SD
01
—
QMHP
STATE QMHP CERTIFICATE
SD
Enumeration date
10/05/2022
Last updated
02/10/2026
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