Provider Demographics
NPI:1235238189
Name:TALBOT, ANNE E (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1680
Mailing Address - Country:US
Mailing Address - Phone:308-632-8547
Mailing Address - Fax:308-632-0135
Practice Address - Street 1:2622 AVENUE C
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1680
Practice Address - Country:US
Practice Address - Phone:308-632-8547
Practice Address - Fax:308-632-0135
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE476103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08071OtherBLUE CROSS BLUE SHIELD
NE47083791626Medicaid
NE6645OtherMIDLANDS CHOICE
NEPO8148Medicare UPIN
NE08071OtherBLUE CROSS BLUE SHIELD