Individual
KATHRYN MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5906 S 169TH ST, OMAHA, NE 68135-2813
(402) 812-5975
(402) 891-8860
Mailing address
5906 S 169TH ST, OMAHA, NE 68135-2813
(402) 812-5975
(402) 891-8860
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-236360
BACB
—
Enumeration date
09/27/2022
Last updated
09/27/2022
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