Provider Demographics
NPI:1255883286
Name:HERZBERG, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 ANNE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2007
Mailing Address - Country:US
Mailing Address - Phone:712-210-0840
Mailing Address - Fax:
Practice Address - Street 1:1101 E SUMMIT ST STE 2
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-2049
Practice Address - Country:US
Practice Address - Phone:712-210-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health