Provider Demographics
NPI:1780238261
Name:LAUDENKLOS, JULIANNE MARIE (LIMHP)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:MARIE
Last Name:LAUDENKLOS
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:MARIE
Other - Last Name:WILKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3805 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2233
Mailing Address - Country:US
Mailing Address - Phone:402-500-6870
Mailing Address - Fax:402-500-6871
Practice Address - Street 1:3805 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2233
Practice Address - Country:US
Practice Address - Phone:402-500-6870
Practice Address - Fax:402-500-6871
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health