Provider Demographics
NPI:1114910023
Name:RIST, KATHRYN E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:E
Last Name:RIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 W CENTER RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1900
Mailing Address - Country:US
Mailing Address - Phone:402-399-9305
Mailing Address - Fax:402-397-3191
Practice Address - Street 1:9239 W CENTER RD
Practice Address - Street 2:SUITE 211
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1900
Practice Address - Country:US
Practice Address - Phone:402-399-9305
Practice Address - Fax:402-397-3191
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82096OtherBCBS
NE273622Medicare ID - Type Unspecified
NE82096OtherBCBS