Provider Demographics
NPI:1437729134
Name:KIRKPATRICK, ROSE ELLEN (NCC, PLMHP, TLMHC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ELLEN
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:NCC, PLMHP, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1124
Mailing Address - Country:US
Mailing Address - Phone:712-371-3959
Mailing Address - Fax:
Practice Address - Street 1:902 S 6TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-6441
Practice Address - Country:US
Practice Address - Phone:712-325-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12542101YM0800X
IA108585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health