Provider Demographics
NPI:1639162548
Name:KUTLER, SANDRA A
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:KUTLER
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 1:12818 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3733
Mailing Address - Country:US
Mailing Address - Phone:402-334-1122
Mailing Address - Fax:402-334-8171
Practice Address - Street 1:12818 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3733
Practice Address - Country:US
Practice Address - Phone:402-334-1122
Practice Address - Fax:402-334-8171
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE377101YM0800X
NE70101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076860626Medicaid
NE098002A5Medicare ID - Type Unspecified