| Diedre Shaw | |
|
330 N 48th St Ste A Lincoln NE 68504-3515 | |
| (402) 326-9168 | |
| (402) 817-1172 |
| Full Name | Diedre Shaw |
|---|---|
| Speciality | Counselor |
| Location | 330 N 48th St Ste A, Lincoln, Nebraska |
| Authorized Official Name and Position | Asia Ali (BILLING SPECIALIST) |
| Authorized Official Contact | 4024131684 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diedre Shaw 330 N 48th St Ste A Lincoln NE 68504-3515 Ph: (402) 326-9168 | Diedre Shaw 330 N 48th St Ste A Lincoln NE 68504-3515 Ph: (402) 326-9168 |
| NPI Number | 1437725603 |
|---|---|
| Provider Enumeration Date | 05/28/2021 |
| Last Update Date | 11/01/2024 |
| Certification Date | 11/01/2024 |
| Medicare PECOS PAC ID | 2264808914 |
|---|---|
| Medicare Enrollment ID | O20221020001027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437725603 | NPI | - | NPPES |
| 10026878800 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Diedre Michelle Schaub |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275198194 PECOS PAC ID: 2769715564 Enrollment ID: I20190611000686 |
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