Healthcare Provider Details

I. General information

NPI: 1588917710
Provider Name (Legal Business Name): JESSICA KRZYKOWSKI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 S 80TH AVE STE 110
OMAHA NE
68124-3253
US

IV. Provider business mailing address

2808 S 80TH AVE STE 110
OMAHA NE
68124-3253
US

V. Phone/Fax

Practice location:
  • Phone: 405-504-3707
  • Fax:
Mailing address:
  • Phone: 405-504-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number745
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: