Provider Demographics
NPI:1497271944
Name:KENNEY, CATELYN CHRISTINE (EDS)
Entity Type:Individual
Prefix:
First Name:CATELYN
Middle Name:CHRISTINE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:CATELYN
Other - Middle Name:CHRISTINE
Other - Last Name:CANTRIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4237 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 N 33RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3221
Practice Address - Country:US
Practice Address - Phone:308-672-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2016008213103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool