Healthcare Provider Details

I. General information

NPI: 1285957415
Provider Name (Legal Business Name): SANDRA HALE KROEKER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 17TH ST
HENDERSON NE
68371-8906
US

IV. Provider business mailing address

PO BOX 684 1080 17TH ST.
HENDERSON NE
68371-0684
US

V. Phone/Fax

Practice location:
  • Phone: 402-723-4883
  • Fax: 402-723-4914
Mailing address:
  • Phone: 402-723-4883
  • Fax: 402-723-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number64
License Number StateNE

VIII. Authorized Official

Name: SANDRA HALE KROEKER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 402-723-4883