Healthcare Provider Details

I. General information

NPI: 1225925175
Provider Name (Legal Business Name): TERESA GOTCHALL ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W 1ST ST
OGALLALA NE
69153-2520
US

IV. Provider business mailing address

314 W 1ST ST
OGALLALA NE
69153-2520
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-8481
  • Fax: 308-284-8483
Mailing address:
  • Phone: 308-284-8481
  • Fax: 308-284-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20220001069
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: