Provider Demographics
NPI:1982777124
Name:PELSTER-HESS, BROOKE (LADC 781)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:PELSTER-HESS
Suffix:
Gender:F
Credentials:LADC 781
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 VICKI LN STE 105
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4542
Mailing Address - Country:US
Mailing Address - Phone:402-256-7883
Mailing Address - Fax:
Practice Address - Street 1:1909 VICKI LN STE 105
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4542
Practice Address - Country:US
Practice Address - Phone:402-256-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47057655277Medicaid
2810003Medicare ID - Type Unspecified