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NPI Code Detail

MEDICARE: DR. KENNETH DOUGLAS SHAMLIAN PSYD, BCBA-D

MEDICARE: DR. KENNETH DOUGLAS SHAMLIAN PSYD, BCBA-D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-10-7098
2103T00000XPsychologist21219NY
3103T00000XPsychologist856NE

General Provider Information

NPI Number : 1568780732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH DOUGLAS SHAMLIAN PSYD, BCBA-D
Provider Business Mailing Address
First Line : 985450 NEBRASKA MEDICAL CTR
Second Line :
City : OMAHA
State : NE
Zip : 68198-5450
Country : US
Telephone Number : 402-559-6408
Fax Number : 402-559-5737
Provider Business Practice Location Address
First Line : 3775 45TH AVE
Second Line :
City : COLUMBUS
State : NE
Zip : 68601-4427
Country : US
Telephone Number : 402-564-7200
Fax Number : 402-559-5737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2010
Last Update Date : 06/28/2023

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