Healthcare Provider Details

I. General information

NPI: 1235009309
Provider Name (Legal Business Name): SUSANNA F. OLIVER MA; CAGS; DOCTOR OF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CALVERT ST
LINCOLN NE
68502-4817
US

IV. Provider business mailing address

2400 W STIRRUP DR
LINCOLN NE
68523-9396
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1123
  • Fax:
Mailing address:
  • Phone: 443-340-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: