Provider Demographics
NPI:1659055051
Name:NEHLSEN, KADEEM
Entity Type:Individual
Prefix:
First Name:KADEEM
Middle Name:
Last Name:NEHLSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 TOSTEVIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-7747
Mailing Address - Country:US
Mailing Address - Phone:712-713-9820
Mailing Address - Fax:
Practice Address - Street 1:1813 TOSTEVIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-7747
Practice Address - Country:US
Practice Address - Phone:712-713-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities