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General NPI Number Information
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NPI Number | 1861700296
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Entity Type | Individual
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Provider Name | NICOLE ELAINE RADTKE
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Gender | Female
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 4600 VALLEY RD STE 350
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City | LINCOLN
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State | NE
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Zip | 68510-4844
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Country | US
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Telephone | 402-474-0011
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Fax | 402-474-0012
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Provider Business Mailing Address
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Address Line | 815 K ST
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City | LINCOLN
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State | NE
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Zip | 68508-2960
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Country | US
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Telephone | 402-474-0011
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Fax | 402-474-0012
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2443
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3875
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License Number State | NE
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