Provider Demographics
NPI:1003031758
Name:NARDUCCIE, SUSAN K (LMHP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:NARDUCCIE
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641130
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7130
Mailing Address - Country:US
Mailing Address - Phone:402-572-2907
Mailing Address - Fax:402-572-3544
Practice Address - Street 1:600 FREMONT ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1539
Practice Address - Country:US
Practice Address - Phone:712-246-5506
Practice Address - Fax:712-246-5506
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health