Healthcare Provider Details

I. General information

NPI: 1104638766
Provider Name (Legal Business Name): CHERYL SEALS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 S 72ND ST
OMAHA NE
68124-3500
US

IV. Provider business mailing address

3047 S 72ND ST
OMAHA NE
68124-3500
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-7116
  • Fax:
Mailing address:
  • Phone: 402-933-7116
  • Fax: 402-933-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCCC9726
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: