Provider Demographics
NPI:1659465441
Name:VERMAAS, KENNETH WILLIAM III (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:VERMAAS
Suffix:III
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1120
Mailing Address - Country:US
Mailing Address - Phone:402-873-7262
Mailing Address - Fax:
Practice Address - Street 1:1903 4TH CORSO
Practice Address - Street 2:BLUE VALLEY BEHAVIORAL HEALTH
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2601
Practice Address - Country:US
Practice Address - Phone:402-873-5505
Practice Address - Fax:402-873-6374
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025208200Medicaid
NE470528515-01Medicaid
NE08237OtherBCBS
NE10025207700Medicaid
NE470528515-04Medicaid
NE10025208700Medicaid
NE470528515-08Medicaid
NE10025208500Medicaid
NE10025208600Medicaid
NE470528515-10Medicaid
NE10025208000Medicaid
NE470528515-02Medicaid
NE96005OtherBCBS AUX NUMBER
NE10025208700Medicaid
NE10025208500Medicaid
NE10025208000Medicaid