Provider Demographics
NPI:1619022571
Name:KOHL, RODNEY WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:WILLIAM
Last Name:KOHL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 NORMANDY CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1474
Mailing Address - Country:US
Mailing Address - Phone:402-420-1617
Mailing Address - Fax:402-420-1619
Practice Address - Street 1:1617 NORMANDY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1474
Practice Address - Country:US
Practice Address - Phone:402-420-1617
Practice Address - Fax:402-420-1619
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE434103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470817089-00Medicaid
NE08416OtherBCBS
NE08416OtherBCBS