Provider Demographics
NPI:1720852155
Name:PARKER, IVY GWEN
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:GWEN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:IVY
Other - Middle Name:GWEN
Other - Last Name:WOOSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1016 B ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-1242
Mailing Address - Country:US
Mailing Address - Phone:402-875-8865
Mailing Address - Fax:
Practice Address - Street 1:3801 UNION DR STE 206
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6652
Practice Address - Country:US
Practice Address - Phone:402-432-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician