Provider Demographics
NPI:1669816294
Name:DEGODT, HEIDI L (PMSW, PMHP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:DEGODT
Suffix:
Gender:F
Credentials:PMSW, PMHP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:L
Other - Last Name:SUKUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMSW, PMHP
Mailing Address - Street 1:715 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4451
Mailing Address - Country:US
Mailing Address - Phone:402-460-5836
Mailing Address - Fax:402-460-5829
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-463-7711
Practice Address - Fax:402-461-5099
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9428101YM0800X
NE6773104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health