Provider Demographics
NPI:1679048789
Name:ALLMENDINGER, KAYLA JO (PLADC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JO
Last Name:ALLMENDINGER
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 SERUM AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4281
Mailing Address - Country:US
Mailing Address - Phone:402-991-8824
Mailing Address - Fax:402-991-3486
Practice Address - Street 1:7703 SERUM AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-4281
Practice Address - Country:US
Practice Address - Phone:402-991-8824
Practice Address - Fax:402-991-3486
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP1548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1073549747Medicaid