Provider Demographics
NPI:1548615214
Name:REIDL, DANETTE D (LIMHP)
Entity Type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:D
Last Name:REIDL
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3329
Mailing Address - Country:US
Mailing Address - Phone:402-671-8591
Mailing Address - Fax:
Practice Address - Street 1:4505 AURORA DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3329
Practice Address - Country:US
Practice Address - Phone:402-671-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026589300Medicaid