Provider Demographics
NPI:1952840001
Name:ADDAMS, KALAN ELAINE (RBT)
Entity Type:Individual
Prefix:
First Name:KALAN
Middle Name:ELAINE
Last Name:ADDAMS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KALAN
Other - Middle Name:ELAINE
Other - Last Name:HAGERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1012 LINCOLN RD
Mailing Address - Street 2:STE B
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3102
Mailing Address - Country:US
Mailing Address - Phone:402-934-6033
Mailing Address - Fax:402-452-3878
Practice Address - Street 1:1012 LINCOLN RD
Practice Address - Street 2:STE B
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3102
Practice Address - Country:US
Practice Address - Phone:402-934-6033
Practice Address - Fax:402-452-3878
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-15-02326106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician