Provider Demographics
NPI:1255529145
Name:KROEKER, SANDRA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:KROEKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:HALE
Other - Last Name:KROEKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1080 17TH ST
Mailing Address - Street 2:P O BOX 684
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-8906
Mailing Address - Country:US
Mailing Address - Phone:402-723-4883
Mailing Address - Fax:402-723-4914
Practice Address - Street 1:1080 17TH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-8906
Practice Address - Country:US
Practice Address - Phone:402-723-4883
Practice Address - Fax:402-723-4914
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE33101YM0800X
NE761041C0700X
NE64106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069582800Medicaid
NE47069582800Medicaid