Individual
RICHARD LEE KISSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1811 W. 2ND ST., SUITE 450, GRAND ISLAND, NE 68803-7543
(308) 379-8619
Mailing address
1811 W. 2ND ST., SUITE 450, GRAND ISLAND, NE 68803-5473
(308) 379-8619
(308) 675-2690
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NE
Other
Enumeration date
12/23/2021
Last updated
12/23/2021
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