Provider Demographics
NPI:1417010661
Name:MULLIGAN, SUZAN J (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:J
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S 9TH ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2247
Mailing Address - Country:US
Mailing Address - Phone:402-477-8278
Mailing Address - Fax:402-477-8284
Practice Address - Street 1:315 S 9TH ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2247
Practice Address - Country:US
Practice Address - Phone:402-477-8278
Practice Address - Fax:402-477-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP 881 LCSW 6491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8857OtherMIDLANDS CHOICE
NE82460OtherBLUE CROSS OF NEBRASKA
NE276145Medicare ID - Type Unspecified