Provider Demographics
NPI:1760265201
Name:PROSKOCIL, KATHARYN L
Entity Type:Individual
Prefix:
First Name:KATHARYN
Middle Name:L
Last Name:PROSKOCIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 N ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1814
Mailing Address - Country:US
Mailing Address - Phone:308-223-0484
Mailing Address - Fax:
Practice Address - Street 1:76 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4841
Practice Address - Country:US
Practice Address - Phone:308-237-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health