Provider Demographics
NPI:1922574151
Name:WEGNER, HANNAH JO (EDS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:JO
Last Name:WEGNER
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-1807
Mailing Address - Country:US
Mailing Address - Phone:308-946-3055
Mailing Address - Fax:
Practice Address - Street 1:1711 15TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-1807
Practice Address - Country:US
Practice Address - Phone:308-946-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2014011418103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2014011418OtherNEBRASKA DEPARTMENT OF EDUCATION