Provider Demographics
NPI:1700537420
Name:KERN, ROSE SHARAN (MAMT, MT-BC, PLMHP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:SHARAN
Last Name:KERN
Suffix:
Gender:F
Credentials:MAMT, MT-BC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15325 TUCKER ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1857
Mailing Address - Country:US
Mailing Address - Phone:402-860-3324
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 542
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2945
Practice Address - Country:US
Practice Address - Phone:402-401-4445
Practice Address - Fax:402-702-0583
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health