Healthcare Provider Details

I. General information

NPI: 1114836715
Provider Name (Legal Business Name): SAMANTHA DICKSON CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 DODGE ST
OMAHA NE
68131-3218
US

IV. Provider business mailing address

14841 GRANT ST
OMAHA NE
68116-5119
US

V. Phone/Fax

Practice location:
  • Phone: 402-612-5878
  • Fax:
Mailing address:
  • Phone: 402-612-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPS-544
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: