Healthcare Provider Details

I. General information

NPI: 1851684450
Provider Name (Legal Business Name): JOSEPHINE K STUDNICKA PLCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI K STUDNICKA PLCSW

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 OLD FAIR RD
GRAND ISLAND NE
68803-5271
US

IV. Provider business mailing address

2608 OLD FAIR RD
GRAND ISLAND NE
68803-5271
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-5297
  • Fax: 308-382-5315
Mailing address:
  • Phone: 308-382-5297
  • Fax: 308-382-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9396
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6767
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: