Provider Demographics
NPI:1801984752
Name:BOE SIMMONS, KRISTINE ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ROSE
Last Name:BOE SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ROSE
Other - Last Name:BOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1700 N VICTORY RD
Mailing Address - Street 2:BOX 1209
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6859
Mailing Address - Country:US
Mailing Address - Phone:402-370-3400
Mailing Address - Fax:
Practice Address - Street 1:1700 N VICTORY RD
Practice Address - Street 2:BOX 1209
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-6859
Practice Address - Country:US
Practice Address - Phone:402-370-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE269116Medicare ID - Type Unspecified