Provider Demographics
NPI:1437792439
Name:WILWERDING, LISA ANN (LIMHP, PLADAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:WILWERDING
Suffix:
Gender:F
Credentials:LIMHP, PLADAC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:OSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10826 OLD MILL RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2660
Mailing Address - Country:US
Mailing Address - Phone:402-469-5843
Mailing Address - Fax:
Practice Address - Street 1:10826 OLD MILL RD STE 103A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2660
Practice Address - Country:US
Practice Address - Phone:402-469-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1729101YA0400X
NE12031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)