Provider Demographics
NPI:1659775104
Name:BROWN, KATHERINE ROSE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:LICHTBLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-8863
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:6405 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-3727
Practice Address - Country:US
Practice Address - Phone:435-797-0576
Practice Address - Fax:844-308-5865
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10907101YM0800X
UT11569185-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health