Healthcare Provider Details

I. General information

NPI: 1750075966
Provider Name (Legal Business Name): KAYLEE PETSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16925 PARKER PLZ
OMAHA NE
68118-6013
US

IV. Provider business mailing address

16925 PARKER PLZ
OMAHA NE
68118-6013
US

V. Phone/Fax

Practice location:
  • Phone: 402-230-5861
  • Fax: 531-200-5808
Mailing address:
  • Phone: 402-230-5861
  • Fax: 531-200-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2828990
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: