=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194818831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAYNE ROGER PRICE PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 12/02/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 SO. 40TH. ST.
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-228-2620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 NORTH EIGHTH STREET
-----------------------------------------------------
City | BEATRICE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68310-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-228-2620
-----------------------------------------------------
Fax | 402-228-2620
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 26
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------