Provider Demographics
NPI:1073491288
Name:SHANMUGAM, KATHERINE MARIE (MSW, PLMHP, PCMSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:SHANMUGAM
Suffix:
Gender:F
Credentials:MSW, PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16704 S ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2308
Mailing Address - Country:US
Mailing Address - Phone:402-679-1771
Mailing Address - Fax:
Practice Address - Street 1:8998 L ST STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1400
Practice Address - Country:US
Practice Address - Phone:402-651-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE82691041C0700X
NE14578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical