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General NPI Number Information
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NPI Number | 1346777562
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Entity Type | Individual
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Provider Name | KENNETH BRADLEY LUEDKE PLADC
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Gender | Male
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 05/18/2017
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Provider Practice Location Address
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Address Line | 4706 SOUTH 48TH ST
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City | LINCOLN
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State | NE
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Zip | 68516
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Country | US
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Telephone | 402-489-9792
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Fax | 402-489-9793
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Provider Business Mailing Address
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Address Line | 331 INDIAN RD
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City | LINCOLN
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State | NE
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Zip | 68505
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Country | US
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Telephone | 402-318-4693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | P-1492
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NE
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