Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 1439 | SC |
Y | 103TC1900X | Counseling Psychologist | 971 | NE |
NPI | 1053850685 |
---|---|
Provider Name | Dr. Kristen A. Menke |
First Address | Omaha, NE 68164-3670 |
Second Address | Omaha, NE 68164-3670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 24/06/2019 |