Healthcare Provider Details

I. General information

NPI: 1457239394
Provider Name (Legal Business Name): LACEY JORDAN FARRINGTON EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 Q ST
GERING NE
69341-2972
US

IV. Provider business mailing address

800 Q ST
GERING NE
69341-2972
US

V. Phone/Fax

Practice location:
  • Phone: 308-641-5298
  • Fax:
Mailing address:
  • Phone: 308-436-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4979553973
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: