Provider Demographics
NPI:1760474902
Name:SCHLEGEL, SUSAN JAYNE (LADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JAYNE
Last Name:SCHLEGEL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12063 BURDETTE CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3425
Mailing Address - Country:US
Mailing Address - Phone:402-498-0716
Mailing Address - Fax:402-552-7016
Practice Address - Street 1:11212 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5624
Practice Address - Country:US
Practice Address - Phone:402-552-7001
Practice Address - Fax:402-552-7016
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELADC316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)