Provider Demographics
NPI:1750314787
Name:PLASEK, GAIL M (LIMHP, LMHP, LCSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:PLASEK
Suffix:
Gender:F
Credentials:LIMHP, LMHP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 R RD
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-7038
Mailing Address - Country:US
Mailing Address - Phone:402-721-1107
Mailing Address - Fax:402-721-1094
Practice Address - Street 1:224 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5693
Practice Address - Country:US
Practice Address - Phone:402-721-1107
Practice Address - Fax:402-721-1094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22361041C0700X
NE10051041C0700X
NE1081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025879700Medicaid
NE10025115400Medicaid
NE208498365Medicare UPIN
NENA1754Medicare PIN
NE278381Medicare ID - Type Unspecified
NE10025879700Medicaid