Healthcare Provider Details

I. General information

NPI: 1831388826
Provider Name (Legal Business Name): JOHN W. HERDMAN, PH.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 L ST STE C
LINCOLN NE
68508-2581
US

IV. Provider business mailing address

4706 S 48TH ST
LINCOLN NE
68516-1276
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-9792
  • Fax: 402-489-9793
Mailing address:
  • Phone: 402-489-9792
  • Fax: 402-489-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN W HEDMAN
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 402-489-9792