Provider Demographics
NPI:1932644051
Name:CONRAD, JASON CARL (LADC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CARL
Last Name:CONRAD
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N COTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1834
Mailing Address - Country:US
Mailing Address - Phone:402-435-3165
Mailing Address - Fax:402-435-0430
Practice Address - Street 1:1124 N COTNER BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1834
Practice Address - Country:US
Practice Address - Phone:402-435-3165
Practice Address - Fax:402-435-0430
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE075101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)