Provider Demographics
NPI:1215106547
Name:ALDENTALER, HEATHER R
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:ALDENTALER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 8TH AVE NW STE 205
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2765
Mailing Address - Country:US
Mailing Address - Phone:605-725-9565
Mailing Address - Fax:844-651-2144
Practice Address - Street 1:405 8TH AVE NW STE 205
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2765
Practice Address - Country:US
Practice Address - Phone:605-725-9565
Practice Address - Fax:844-651-2144
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30531101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2018402Medicaid