Provider Demographics
NPI:1760517601
Name:SMALL, LINDA CATHERINE (MA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CATHERINE
Last Name:SMALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S 40TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5248
Mailing Address - Country:US
Mailing Address - Phone:402-441-9280
Mailing Address - Fax:
Practice Address - Street 1:1919 S 40TH ST STE 212
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5248
Practice Address - Country:US
Practice Address - Phone:402-441-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7525101YM0800X
NE57543163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075636926OtherPLAZA MEDICAID SITE #
NE96079OtherBC&BS PROVISIONAL M H
NE96079OtherBC&BS PROVISIONAL M H