Provider Demographics
NPI:1427506179
Name:BRUGGER, KERI JEAN (LIMHP, LADC)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:JEAN
Last Name:BRUGGER
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:JEAN
Other - Last Name:BUCKENDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP, LADC
Mailing Address - Street 1:712 W KOENIG ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6556
Mailing Address - Country:US
Mailing Address - Phone:402-741-9444
Mailing Address - Fax:
Practice Address - Street 1:712 W KOENIG ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6556
Practice Address - Country:US
Practice Address - Phone:402-741-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025173100Medicaid