Provider Demographics
NPI:1295516581
Name:DWORAK, AUDREY (PLMHP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DWORAK
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 1:1820 SAINT JAMES RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1654
Mailing Address - Country:US
Mailing Address - Phone:402-470-1649
Mailing Address - Fax:
Practice Address - Street 1:444 REGENCY PARKWAY DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3792
Practice Address - Country:US
Practice Address - Phone:402-715-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health