Provider Demographics
NPI:1427368224
Name:HENNING, REBECCA KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KAY
Last Name:HENNING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:KAY
Other - Last Name:WIDOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:15418 WEIR ST # 142
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5045
Mailing Address - Country:US
Mailing Address - Phone:531-222-4147
Mailing Address - Fax:
Practice Address - Street 1:4428 SOUTH 162ND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135
Practice Address - Country:US
Practice Address - Phone:531-222-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical