Healthcare Provider Details

I. General information

NPI: 1336187905
Provider Name (Legal Business Name): ELIZABETH ANN HEIDT KOZISEK PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH A HEIDT PH D

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 EAGLE RD
SAINT LIBORY NE
68872-2801
US

IV. Provider business mailing address

106 EAGLE RD
SAINT LIBORY NE
68872-2801
US

V. Phone/Fax

Practice location:
  • Phone: 308-379-1949
  • Fax: 308-687-6309
Mailing address:
  • Phone: 308-379-1949
  • Fax: 308-687-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number451
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number451
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: