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General NPI Number Information
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NPI Number | 1356720973
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Entity Type | Individual
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Provider Name | AMANDA WEAKLEND
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Gender | Female
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 7100 S 29TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-6057
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Country | US
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Telephone | 402-476-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 20714 CEDAR CIR
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City | GRETNA
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State | NE
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Zip | 68028-6930
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Country | US
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Telephone | 701-367-3703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10488
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License Number State | NE
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