Provider Demographics
NPI:1386331213
Name:SPECKMANN, KAYLEE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:SPECKMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 N 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6195
Mailing Address - Country:US
Mailing Address - Phone:402-650-3501
Mailing Address - Fax:
Practice Address - Street 1:20010 MANDERSON ST STE 104
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-1264
Practice Address - Country:US
Practice Address - Phone:972-777-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374J00000XNursing Service Related ProvidersDoula