Provider Demographics
NPI:1245586023
Name:KIEFFE, MICHELLE ROSE WOIDNECK (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ROSE WOIDNECK
Last Name:KIEFFE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ROSE
Other - Last Name:WOIDNECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:9330 KRUG AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2852
Mailing Address - Country:US
Mailing Address - Phone:402-281-9457
Mailing Address - Fax:402-702-1244
Practice Address - Street 1:11905 ARBOR ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2970
Practice Address - Country:US
Practice Address - Phone:402-281-9457
Practice Address - Fax:402-702-1244
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE860103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026251000Medicaid
NE470376606-31Medicaid
NE470376606-24Medicaid