Healthcare Provider Details

I. General information

NPI: 1457407884
Provider Name (Legal Business Name): SUSAN E. WRAGGE MA, LMHP, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 S 70TH ST SUITE 150
LINCOLN NE
68506-3688
US

IV. Provider business mailing address

2900 S 70TH ST SUITE 150
LINCOLN NE
68506-3688
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-1101
  • Fax: 402-486-1614
Mailing address:
  • Phone: 402-486-1101
  • Fax: 402-486-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2301
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: