Provider Demographics
NPI:1255493250
Name:CALLAN, KATIE JO (LIMHP, CMSW)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:JO
Last Name:CALLAN
Suffix:
Gender:F
Credentials:LIMHP, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 OSBORNE DR W
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-9158
Mailing Address - Country:US
Mailing Address - Phone:504-319-1570
Mailing Address - Fax:
Practice Address - Street 1:5807 OSBORNE DR W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9158
Practice Address - Country:US
Practice Address - Phone:402-463-5611
Practice Address - Fax:402-463-9555
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9261104100000X
NE17071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker