Healthcare Provider Details

I. General information

NPI: 1851100150
Provider Name (Legal Business Name): MS. LAUREN JO MICHALEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E 22ND ST STE 5
FREMONT NE
68025-2661
US

IV. Provider business mailing address

4711 N 191ST ST
ELKHORN NE
68022-5840
US

V. Phone/Fax

Practice location:
  • Phone: 402-356-3332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14202
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: