Provider Demographics
NPI:1508109638
Name:DOUD, KATHERINE M (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:DOUD
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 1:3901 PINE LAKE RD STE 410
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5415
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:3901 PINE LAKE RD STE 410
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-434-3970
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE980103T00000X
NE598103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026721201Medicaid
NE47075636930Medicaid