Provider Demographics
NPI:1003002981
Name:KIMMERLING, KATHERINE (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KIMMERLING
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:HRUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP, LADC
Mailing Address - Street 1:730 FORT CROOK RD N
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4558
Mailing Address - Country:US
Mailing Address - Phone:402-661-3131
Mailing Address - Fax:402-292-0342
Practice Address - Street 1:730 FORT CROOK RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4558
Practice Address - Country:US
Practice Address - Phone:402-292-9105
Practice Address - Fax:402-292-0342
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3049101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660631Medicaid