Provider Demographics
NPI:1275528101
Name:SEDLACEK, CAROLINE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:G
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506 BURT CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2094
Mailing Address - Country:US
Mailing Address - Phone:402-493-4444
Mailing Address - Fax:402-493-1550
Practice Address - Street 1:10506 BURT CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2094
Practice Address - Country:US
Practice Address - Phone:402-493-4444
Practice Address - Fax:402-493-1550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470833060-13OtherMEDICAID-NEUROPSYCH
NE470833060-26Medicaid
NE470833060Medicare UPIN
NE470833060-13OtherMEDICAID-NEUROPSYCH