Provider Demographics
NPI:1083787881
Name:MAGNUSON, JUDY CATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:CATHERINE
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:CATHERINE
Other - Last Name:MAGNUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7441 O ST STE 402
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2466
Mailing Address - Country:US
Mailing Address - Phone:402-875-2196
Mailing Address - Fax:833-475-3182
Practice Address - Street 1:4830 WILSHIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3365
Practice Address - Country:US
Practice Address - Phone:402-875-2196
Practice Address - Fax:833-475-3182
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE345810000OtherMAGELLAN
NE456304000OtherMAGELLAN
NE47075636926Medicaid
NE81127OtherBCBS
NE34568000OtherMAGELLAN
NE47075636930Medicaid
NE08420OtherBCBS
NE$$$$$$$$$26Medicaid
NE47075636926Medicaid
NE47075636930Medicaid
NE261800Medicare PIN