Provider Demographics
NPI:1194818831
Name:PRICE, WAYNE ROGER (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ROGER
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NORTH EIGHTH STREET
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2342
Mailing Address - Country:US
Mailing Address - Phone:402-228-2620
Mailing Address - Fax:402-228-2620
Practice Address - Street 1:1919 SO. 40TH. ST.
Practice Address - Street 2:
Practice Address - City:LINCOLN,
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-228-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08230OtherBLUE CROSS/ BLUE SHIELD