Provider Demographics
NPI:1477053866
Name:SEVIER, JOSHUA DALE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DALE
Last Name:SEVIER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LEAVENWORTH ST APT 429
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2947
Mailing Address - Country:US
Mailing Address - Phone:615-714-4552
Mailing Address - Fax:
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:531-355-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE344231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28Medicaid