Provider Demographics
NPI:1265529143
Name:LAING, JEAN AGNES (PHD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:AGNES
Last Name:LAING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N VICTORY RD
Mailing Address - Street 2:BOX 1209
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6859
Mailing Address - Country:US
Mailing Address - Phone:402-370-3400
Mailing Address - Fax:
Practice Address - Street 1:1700 N VICTORY RD
Practice Address - Street 2:BOX 1209
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-6859
Practice Address - Country:US
Practice Address - Phone:402-370-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE276140Medicare ID - Type Unspecified