Healthcare Provider Details

I. General information

NPI: 1053985853
Provider Name (Legal Business Name): ELIZABETH TAMPKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 WALSH DR
BOYS TOWN NE
68010-7529
US

IV. Provider business mailing address

13460 WALSH DR
BOYS TOWN NE
68010-7529
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-3358
  • Fax: 531-355-3375
Mailing address:
  • Phone: 531-355-3358
  • Fax: 531-355-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12558
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS02276
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: