Provider Demographics
NPI:1003362146
Name:WEAVER, BRETT (PLADC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 FOCH ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1709
Mailing Address - Country:US
Mailing Address - Phone:308-282-1101
Mailing Address - Fax:308-282-1372
Practice Address - Street 1:305 FOCH ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1709
Practice Address - Country:US
Practice Address - Phone:308-282-1101
Practice Address - Fax:308-282-1372
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470734376-86Medicaid