Provider Demographics
NPI:1013146455
Name:ROOT, KALAN D (PLMHP AND PCMSW)
Entity Type:Individual
Prefix:MRS
First Name:KALAN
Middle Name:D
Last Name:ROOT
Suffix:
Gender:F
Credentials:PLMHP AND PCMSW
Other - Prefix:
Other - First Name:KALAN
Other - Middle Name:D
Other - Last Name:BROEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1252 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-2240
Mailing Address - Country:US
Mailing Address - Phone:402-416-6885
Mailing Address - Fax:
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-481-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6573104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker