Provider Demographics
NPI:1275548133
Name:CONOLEY, COLLEEN ADELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ADELE
Last Name:CONOLEY
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 1:11330 Q ST
Mailing Address - Street 2:STE. 232
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-597-2290
Mailing Address - Fax:402-597-2345
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:STE. 232
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-597-2290
Practice Address - Fax:402-597-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE642103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025420600Medicaid
NE10025173700Medicaid