Healthcare Provider Details

I. General information

NPI: 1669410668
Provider Name (Legal Business Name): KRISHA SUE UDEN MS LIMHP LMHP LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISHA SUE NIEMOTH MS LMHP LPC LIMHP

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 W ROSEDALE RD
WOOD RIVER NE
68883-1771
US

IV. Provider business mailing address

12505 W ROSEDALE RD
WOOD RIVER NE
68883-1771
US

V. Phone/Fax

Practice location:
  • Phone: 308-379-1958
  • Fax:
Mailing address:
  • Phone: 308-379-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1936
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1119
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106520
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number227
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: