Healthcare Provider Details

I. General information

NPI: 1588535413
Provider Name (Legal Business Name): STACI L NOEHREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W O ST
WEEPING WATER NE
68463-4255
US

IV. Provider business mailing address

9828 EDWARD ST
LA VISTA NE
68128-2517
US

V. Phone/Fax

Practice location:
  • Phone: 402-267-2445
  • Fax:
Mailing address:
  • Phone: 402-598-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: