Healthcare Provider Details

I. General information

NPI: 1972465045
Provider Name (Legal Business Name): MADISON N RAES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 Q ST STE 104
OMAHA NE
68137-3700
US

IV. Provider business mailing address

7929 W CENTER RD
OMAHA NE
68124-3104
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-7940
  • Fax: 402-441-8491
Mailing address:
  • Phone: 402-441-7940
  • Fax: 402-441-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14118
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8100
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: