Healthcare Provider Details

I. General information

NPI: 1003908211
Provider Name (Legal Business Name): GAIL MAUREEN IHLE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 J ST ST 403
LINCOLN NE
68508-2900
US

IV. Provider business mailing address

650 J ST SUITE 403
LINCOLN NE
68508-2900
US

V. Phone/Fax

Practice location:
  • Phone: 402-435-1313
  • Fax: 402-435-5056
Mailing address:
  • Phone: 402-435-1313
  • Fax: 402-435-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number517
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: