Provider Demographics
NPI:1699004465
Name:LACROSSE, GLORIA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:LACROSSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11906 ARBOR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2938
Mailing Address - Country:US
Mailing Address - Phone:402-740-2517
Mailing Address - Fax:402-829-9340
Practice Address - Street 1:11906 ARBOR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2938
Practice Address - Country:US
Practice Address - Phone:402-740-2517
Practice Address - Fax:402-829-9340
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical