Healthcare Provider Details

I. General information

NPI: 1477659290
Provider Name (Legal Business Name): KAY MARIE GUSTAFSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

1700 SKYLINE DR
ELKHORN NE
68022-1741
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7411
  • Fax: 402-294-7085
Mailing address:
  • Phone: 402-658-2415
  • Fax: 402-333-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number69
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number069
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: