Provider Demographics
NPI:1780172304
Name:CREIGHTON UNIVERSITY
Entity type:Organization
Organization Name:CREIGHTON UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:HUGHES-ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-280-2246
Mailing Address - Street 1:17055 FRANCES ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4655
Mailing Address - Country:US
Mailing Address - Phone:402-280-3555
Mailing Address - Fax:402-280-3557
Practice Address - Street 1:17055 FRANCES ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4655
Practice Address - Country:US
Practice Address - Phone:402-280-3555
Practice Address - Fax:402-280-3557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREIGHTON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-30
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2020225100000X
225X00000X, 235Z00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty