Individual
KENNEDY SHORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
333 W NORFOLK AVE STE 201, NORFOLK, NE 68701-5221
(402) 379-2030
Mailing address
333 W NORFOLK AVE STE 201, NORFOLK, NE 68701-5221
(402) 379-2030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
P-2247
NE
175T00000X
Peer Specialist
Primary
399
NE
Other
Enumeration date
02/10/2025
Last updated
04/11/2025
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