Provider Demographics
NPI:1982996351
Name:BASSINGTHWAITE, BRENDA JEAN (PHD)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JEAN
Last Name:BASSINGTHWAITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-6408
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:444 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3727
Practice Address - Country:US
Practice Address - Phone:402-559-6408
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001146103T00000X, 103TB0200X, 103TC2200X
NE1014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0459529Medicaid
IA31342OtherUNKNOWN
IAI8112OtherMEDICARE ID-TYPE UNSPECIFIED
IA31342OtherUNKNOWN