Provider Demographics
NPI:1720344831
Name:WILLIAMS-RUSSELL-EL, KENDRA R (PLADC)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:R
Last Name:WILLIAMS-RUSSELL-EL
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST
Mailing Address - Street 2:412
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2939
Mailing Address - Country:US
Mailing Address - Phone:402-991-8101
Mailing Address - Fax:402-991-8103
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:412
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-991-8101
Practice Address - Fax:402-991-8103
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-735101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)