Doctor Name: | MRS. JORDAN WILLER |
NPI Number: | 1013343706 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 10077 |
Business Practice Address: | 2501 Lakeridge Dr Ste 104c Norfolk, NE - 687012558 |
Business Phone Number: | 4023600055 |
Business Fax Number: | |
Mailing Address: | 1114 S 4th St, NORFOLK |
State: | NE |
Postal Code: | 687016204 |
Phone Number: | 4023600055 |
Fax Number: | |
NPI Enumeration Date: | 09/25/2013 |
NPI Last Update Date: | 09/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 10077 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |