Healthcare Provider Details

I. General information

NPI: 1386331213
Provider Name (Legal Business Name): KAYLEE SPECKMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20010 MANDERSON ST STE 104
ELKHORN NE
68022-1264
US

IV. Provider business mailing address

5126 N 137TH AVE
OMAHA NE
68164-6195
US

V. Phone/Fax

Practice location:
  • Phone: 972-777-1331
  • Fax:
Mailing address:
  • Phone: 402-650-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: