Provider Demographics
NPI:1447763321
Name:KANE, ELISABETH JORDAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:JORDAN
Last Name:KANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N 90TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2766
Mailing Address - Country:US
Mailing Address - Phone:402-955-3900
Mailing Address - Fax:402-955-3920
Practice Address - Street 1:1000 N 90TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2766
Practice Address - Country:US
Practice Address - Phone:402-955-3900
Practice Address - Fax:402-955-3920
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11008101YM0800X
NE1063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health