Provider Demographics
NPI:1083411888
Name:KABORE, PEGDWENDE BERNADIN
Entity type:Individual
Prefix:
First Name:PEGDWENDE
Middle Name:BERNADIN
Last Name:KABORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13545 EMILINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-6114
Mailing Address - Country:US
Mailing Address - Phone:646-431-1535
Mailing Address - Fax:
Practice Address - Street 1:13545 EMILINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-6114
Practice Address - Country:US
Practice Address - Phone:646-431-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily