MEDICARE: MARIAH HERGOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	10893	NE
2	101Y00000X	Counselor	2273	NE

General Provider Information

NPI Number	:	1184072027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH HERGOTT

Provider Business Mailing Address
First Line	:	110 N 37TH ST STE 405
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-3283
Country	:	US
Telephone Number	:	402-230-7576
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 CUSTER AVE STE B
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-0859
Country	:	US
Telephone Number	:	402-230-7576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	02/26/2025

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Directions to “ MARIAH HERGOTT ” Practice Location

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