Provider Demographics
NPI:1134770050
Name:VIDLAK, REBECCA (PLMHP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:VIDLAK
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 N ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1747
Mailing Address - Country:US
Mailing Address - Phone:402-598-8852
Mailing Address - Fax:
Practice Address - Street 1:809 S 174TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3540
Practice Address - Country:US
Practice Address - Phone:402-991-8093
Practice Address - Fax:402-505-9726
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health