Provider Demographics
NPI:1932710092
Name:DE COCKER, ELISABETH PAULA SIMONNE
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:PAULA SIMONNE
Last Name:DE COCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 SEWELL ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3848
Mailing Address - Country:US
Mailing Address - Phone:402-276-2770
Mailing Address - Fax:
Practice Address - Street 1:1540 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1575
Practice Address - Country:US
Practice Address - Phone:402-318-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician