Healthcare Provider Details

I. General information

NPI: 1790664910
Provider Name (Legal Business Name): MADDISON ROSS PIEPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 S 14TH ST
LINCOLN NE
68502-5340
US

IV. Provider business mailing address

874 S 34TH ST
LINCOLN NE
68510-3407
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-8323
  • Fax:
Mailing address:
  • Phone: 402-217-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: