Provider Demographics
NPI:1922726009
Name:MARTIN, CHERYL (PLADC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2431
Mailing Address - Country:US
Mailing Address - Phone:402-441-3765
Mailing Address - Fax:
Practice Address - Street 1:120 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2431
Practice Address - Country:US
Practice Address - Phone:402-441-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP1592101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)