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NPI Code Detail

MEDICARE: DR. STACY ALICE WALDRON PHD

MEDICARE: DR. STACY ALICE WALDRON PHD
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
1103TC1900XCounseling Psychologist60016697NY
2103TC1900XCounseling Psychologist6291316-2501UT
3103TC1900XCounseling Psychologist696NE

General Provider Information

NPI Number : 1295765238
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY ALICE WALDRON PHD
Provider Business Mailing Address
First Line : 2300 S 16TH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-3704
Country : US
Telephone Number : 402-481-5991
Fax Number :
Provider Business Practice Location Address
First Line : 2300 S 16TH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-3704
Country : US
Telephone Number : 402-481-5991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 07/29/2016

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