Provider Demographics
NPI:1558734962
Name:SKRETTA, KYM
Entity Type:Individual
Prefix:
First Name:KYM
Middle Name:
Last Name:SKRETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 N 154TH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1848
Mailing Address - Country:US
Mailing Address - Phone:402-490-2222
Mailing Address - Fax:
Practice Address - Street 1:1010 S 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2801
Practice Address - Country:US
Practice Address - Phone:402-715-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4397746356OtherNDE STAFF ID 4397746356