Provider Demographics
NPI:1679658389
Name:LINDBLAD, SUSAN GERETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GERETTE
Last Name:LINDBLAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 W VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7480
Mailing Address - Country:US
Mailing Address - Phone:402-461-4163
Mailing Address - Fax:
Practice Address - Street 1:5255 W VALLEY RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7480
Practice Address - Country:US
Practice Address - Phone:402-461-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE433103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025439000Medicaid