Provider Demographics
NPI:1245554534
Name:SEDERSTROM, ROBYN MARIE (PLMHP)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:MARIE
Last Name:SEDERSTROM
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 1:1312 N 109TH PLZ
Mailing Address - Street 2:#413
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4963
Mailing Address - Country:US
Mailing Address - Phone:402-639-8799
Mailing Address - Fax:
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:SUITE 212
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-670-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health