Provider Demographics
NPI:1063425171
Name:SWOBODA, JOSEPH STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:SWOBODA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3460
Mailing Address - Country:US
Mailing Address - Phone:402-488-4867
Mailing Address - Fax:402-489-3666
Practice Address - Street 1:3801 UNION DR
Practice Address - Street 2:STE 206
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6652
Practice Address - Country:US
Practice Address - Phone:402-489-2218
Practice Address - Fax:402-489-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025286200Medicaid
NE279314Medicare ID - Type Unspecified