Provider Demographics
NPI:1003942517
Name:VEJVODA, LINDA (LMHP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:VEJVODA
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 1:3231 RAMADA RD STE 9
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8815
Mailing Address - Country:US
Mailing Address - Phone:308-380-8338
Mailing Address - Fax:380-381-8041
Practice Address - Street 1:3231 RAMADA RD STE 9
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-8815
Practice Address - Country:US
Practice Address - Phone:308-380-8338
Practice Address - Fax:380-381-8041
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025292400Medicaid