Healthcare Provider Details

I. General information

NPI: 1841580768
Provider Name (Legal Business Name): KATHRYN MARIE LADD LISW, LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE LADD LISW, LMHP, RPT

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 LEAVENWORTH ST # 103
OMAHA NE
68102-3214
US

IV. Provider business mailing address

1219 LEAVENWORTH ST # 103
OMAHA NE
68102-3214
US

V. Phone/Fax

Practice location:
  • Phone: 402-237-8194
  • Fax: 402-702-1297
Mailing address:
  • Phone: 402-812-1611
  • Fax: 402-702-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1553
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: