Provider Demographics
NPI:1164627378
Name:KOSSE, STACY A (PHD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:KOSSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5497
Mailing Address - Country:US
Mailing Address - Phone:402-465-5600
Mailing Address - Fax:402-437-0854
Practice Address - Street 1:8201 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3092
Practice Address - Country:US
Practice Address - Phone:402-465-5600
Practice Address - Fax:402-437-0854
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47079049100Medicaid