Provider Demographics
NPI:1285957415
Name:SANDRA HALE KROEKER, PC
Entity type:Organization
Organization Name:SANDRA HALE KROEKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:KROEKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:402-723-4883
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:1080 17TH ST.
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-0684
Mailing Address - Country:US
Mailing Address - Phone:402-723-4883
Mailing Address - Fax:402-723-4914
Practice Address - Street 1:1080 17TH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-8906
Practice Address - Country:US
Practice Address - Phone:402-723-4883
Practice Address - Fax:402-723-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE33101YM0800X
NE761041C0700X
NE64106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025795700Medicaid
NE263645KRMedicare PIN