Healthcare Provider Details

I. General information

NPI: 1053945477
Provider Name (Legal Business Name): SHAYLA LINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N LINCOLN AVE
FREMONT NE
68025-3206
US

IV. Provider business mailing address

2828 REED LN
FREMONT NE
68025-7949
US

V. Phone/Fax

Practice location:
  • Phone: 402-941-3148
  • Fax:
Mailing address:
  • Phone: 402-719-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: