Provider Demographics
NPI:1750033387
Name:KLUG, MAKENNA C
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:C
Last Name:KLUG
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 1:1014 BOSWELL AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-3603
Mailing Address - Country:US
Mailing Address - Phone:402-270-9074
Mailing Address - Fax:
Practice Address - Street 1:1014 BOSWELL AVE STE 301
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3603
Practice Address - Country:US
Practice Address - Phone:402-270-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100582973OtherBRIGHT HEALTH