Healthcare Provider Details

I. General information

NPI: 1053226589
Provider Name (Legal Business Name): KELI POEHLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 S 75TH ST
OMAHA NE
68124-1609
US

IV. Provider business mailing address

PO BOX 736707
CHICAGO IL
60673-6707
US

V. Phone/Fax

Practice location:
  • Phone: 469-824-2196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-547199
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: