Provider Demographics
NPI:1336738004
Name:FLESCH, KELLI RAE
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:RAE
Last Name:FLESCH
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 1:803 DARLIN ST
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:NE
Mailing Address - Zip Code:69165-7246
Mailing Address - Country:US
Mailing Address - Phone:308-529-1860
Mailing Address - Fax:
Practice Address - Street 1:601 NORRIS AVE
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3140
Practice Address - Country:US
Practice Address - Phone:308-345-4067
Practice Address - Fax:308-345-0607
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2018004402101YS0200X
NE12472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool