Provider Demographics
NPI:1407562432
Name:DIKE, KENDRA ANNE (PADC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANNE
Last Name:DIKE
Suffix:
Gender:F
Credentials:PADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 24TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1205
Mailing Address - Country:US
Mailing Address - Phone:402-599-2056
Mailing Address - Fax:402-591-5075
Practice Address - Street 1:120 E 12TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-2365
Practice Address - Country:US
Practice Address - Phone:308-532-0587
Practice Address - Fax:308-532-0653
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2033101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)