Individual
LYNELLE HAGEDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20440 476TH AVE, WHITE, SD 57276-5914
(605) 629-8841
Mailing address
20440 476TH AVE, WHITE, SD 57276-5914
(605) 629-8841
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
279A
SD
Other
Enumeration date
09/05/2014
Last updated
09/05/2014
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