Provider Demographics
NPI:1154462836
Name:KREIS, JANICE A (LADC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:KREIS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:NE
Mailing Address - Zip Code:68876-9647
Mailing Address - Country:US
Mailing Address - Phone:308-647-5262
Mailing Address - Fax:
Practice Address - Street 1:2116 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4645
Practice Address - Country:US
Practice Address - Phone:308-398-5427
Practice Address - Fax:308-398-5404
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELADC-624101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NELADC-624OtherLICENSE ALCOHOL DRUG COUN