Healthcare Provider Details

I. General information

NPI: 1770270506
Provider Name (Legal Business Name): ALISSA KOHMETSCHER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

5115 N 158TH AVE APT 123
OMAHA NE
68116-8827
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-5177
  • Fax: 402-930-7068
Mailing address:
  • Phone: 402-540-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2611
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: