Healthcare Provider Details

I. General information

NPI: 1700728656
Provider Name (Legal Business Name): LANETTA EDISON-SOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S 84TH ST STE L101
LINCOLN NE
68510-2601
US

IV. Provider business mailing address

245 S 84TH ST STE L101
LINCOLN NE
68510-2601
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-1182
  • Fax: 402-465-8717
Mailing address:
  • Phone: 402-421-1182
  • Fax: 402-465-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13546
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: