Provider Demographics
NPI:1639622061
Name:ESPENSCHADE, KELLY K (LIMHP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:ESPENSCHADE
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 GLYNOAKS DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6378
Mailing Address - Country:US
Mailing Address - Phone:402-817-2116
Mailing Address - Fax:
Practice Address - Street 1:8333 GLYNOAKS DR STE 180
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6378
Practice Address - Country:US
Practice Address - Phone:402-817-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2903101YM0800X
NE4808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025071300Medicaid