Provider Demographics
NPI:1568780732
Name:SHAMLIAN, KENNETH DOUGLAS (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DOUGLAS
Last Name:SHAMLIAN
Suffix:
Gender:M
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-6408
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:3775 45TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4427
Practice Address - Country:US
Practice Address - Phone:402-564-7200
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7098103K00000X
NY21219103T00000X
NE856103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst