Provider Demographics
NPI:1437948387
Name:HAJI, KHADER I
Entity type:Individual
Prefix:
First Name:KHADER
Middle Name:I
Last Name:HAJI
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 1:5255 NW 12TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4257
Mailing Address - Country:US
Mailing Address - Phone:402-805-1478
Mailing Address - Fax:
Practice Address - Street 1:5255 NW 12TH ST APT 301
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4257
Practice Address - Country:US
Practice Address - Phone:402-805-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13888962103TE1100X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports