Provider Demographics
NPI:1508531880
Name:LANNING, NICOLE (BS, EDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LANNING
Suffix:
Gender:F
Credentials:BS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-2215
Mailing Address - Country:US
Mailing Address - Phone:308-635-6255
Mailing Address - Fax:
Practice Address - Street 1:1722 AVENUE K
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2215
Practice Address - Country:US
Practice Address - Phone:308-635-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20200005626103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool