Provider Demographics
NPI:1689843716
Name:SCHENKELBERG, KIM (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:SCHENKELBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10832 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2672
Mailing Address - Country:US
Mailing Address - Phone:402-250-5466
Mailing Address - Fax:
Practice Address - Street 1:4939 S 118TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2213
Practice Address - Country:US
Practice Address - Phone:402-431-8725
Practice Address - Fax:402-232-7750
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE37531041C0700X
NE1376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker