MEDICARE: KATHLEEN KALLSTROM-SCHRECKENGOST PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	866	NE

General Provider Information

NPI Number	:	1790188951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KALLSTROM-SCHRECKENGOST PSYD

Provider Business Mailing Address
First Line	:	1045 N 115TH ST STE 205
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4422
Country	:	US
Telephone Number	:	402-957-2011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 N 115TH ST STE 205
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4422
Country	:	US
Telephone Number	:	402-957-2011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/07/2025

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