Healthcare Provider Details

I. General information

NPI: 1336607704
Provider Name (Legal Business Name): TARA HIATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S 56TH ST
LINCOLN NE
68506-2111
US

IV. Provider business mailing address

2351 S 89TH ST
LINCOLN NE
68520-1309
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-1500
  • Fax:
Mailing address:
  • Phone: 308-530-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number11719
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: