Healthcare Provider Details

I. General information

NPI: 1225469075
Provider Name (Legal Business Name): POLLY UBBEN M.A., CCC-SLP-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 O ST
LINCOLN NE
68510-1755
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-817-0834
  • Fax: 402-817-0835
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number715
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: