Provider Demographics
NPI:1679933725
Name:STOFFER, KELLI J
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:STOFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:J
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 WEST CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:402-506-9000
Mailing Address - Fax:402-506-9001
Practice Address - Street 1:7100 WEST CENTER ROAD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106
Practice Address - Country:US
Practice Address - Phone:402-506-9000
Practice Address - Fax:402-506-9001
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4706101YM0800X, 1041C0700X
NE1621104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker