=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144117243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHALEE POLLARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2025
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 W 1ST ST
-----------------------------------------------------
City | OGALLALA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69153-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-284-8481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 832 SHERMAN AVE
-----------------------------------------------------
City | GRANT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69140-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-352-6688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 20240008174
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------