Provider Demographics
NPI:1770654436
Name:BENNETT, PAMELA SUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:REJCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:712 13TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305
Mailing Address - Country:US
Mailing Address - Phone:402-274-9408
Mailing Address - Fax:
Practice Address - Street 1:1121 15TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305
Practice Address - Country:US
Practice Address - Phone:402-274-4373
Practice Address - Fax:402-274-5442
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
279894Medicare ID - Type Unspecified