Individual
MR. KELLICE LAJUAN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2564 MARCY ST APT 5, OMAHA, NE 68105-1671
(402) 208-0706
Mailing address
2564 MARCY ST APT 5, OMAHA, NE 68105-1671
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
NE
Other
Enumeration date
03/02/2026
Last updated
03/02/2026
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