Provider Demographics
NPI:1003012139
Name:BLIZEK, MONICA L (LIMHP, CMSW, LADC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:BLIZEK
Suffix:
Gender:F
Credentials:LIMHP, CMSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 MORMON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1929
Mailing Address - Country:US
Mailing Address - Phone:402-991-8509
Mailing Address - Fax:402-455-7050
Practice Address - Street 1:8502 MORMON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-1929
Practice Address - Country:US
Practice Address - Phone:402-991-8509
Practice Address - Fax:402-455-7050
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELADC 824101YA0400X
NELIMHP 473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE348833000OtherMAGELLAN MANAGED CARE
NE82146OtherBLUE CROSS BLUE SHIELD
NE348833000OtherMAGELLAN MANAGED CARE