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General NPI Number Information
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NPI Number | 1366690596
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Entity Type | Organization
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Legal Business Name | KENDRA MCCALLIE LIMHP, LLC
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 535 FORTUNE DR. STE 130
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City | PAPILLION
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State | NE
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Zip | 68046
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Country | US
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Telephone | 402-689-6135
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Fax | 402-916-9757
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Provider Business Mailing Address
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Address Line | 535 FORTUNE DR SUITE 130
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City | PAPILLION
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State | NE
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Zip | 68046-3428
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Country | US
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Telephone | 402-689-6135
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Fax | 402-916-9757
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. KENDRA MCCALLIE
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Credential | LIMHP, CMSW
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Telephone | 402-689-6135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1079
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License Number State | NE
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