Individual
TIFFANY M KODAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
985450 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-5450
(402) 559-8943
Mailing address
985450 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-5450
(402) 559-8943
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
690
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025287200
—
NE
Enumeration date
02/25/2008
Last updated
02/25/2008
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