Healthcare Provider Details

I. General information

NPI: 1497271944
Provider Name (Legal Business Name): CATELYN CHRISTINE KENNEY ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATELYN CHRISTINE CANTRIL

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N 33RD ST
LINCOLN NE
68503-3221
US

IV. Provider business mailing address

4237 RIDGEVIEW DR
LINCOLN NE
68506-5158
US

V. Phone/Fax

Practice location:
  • Phone: 308-672-7594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2016008213
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: