Healthcare Provider Details

I. General information

NPI: 1376871913
Provider Name (Legal Business Name): COLLEEN A. CONOLEY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11330 Q ST STE 232
OMAHA NE
68137-3679
US

IV. Provider business mailing address

11330 Q ST STE 232
OMAHA NE
68137-3679
US

V. Phone/Fax

Practice location:
  • Phone: 402-597-2290
  • Fax: 402-597-2345
Mailing address:
  • Phone: 402-597-2290
  • Fax: 402-597-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number642
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number642
License Number StateNE

VIII. Authorized Official

Name: COLLEEN CONOLEY
Title or Position: PRESIDENT
Credential: PHD
Phone: 402-597-2290