Healthcare Provider Details

I. General information

NPI: 1972688265
Provider Name (Legal Business Name): JOHN W HERDMAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
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 Number451
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number424
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: