Provider Demographics
NPI:1154428894
Name:WEBER, GWEN KATHLEEN (PHD, MSW)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:KATHLEEN
Last Name:WEBER
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5325
Mailing Address - Country:US
Mailing Address - Phone:402-393-7211
Mailing Address - Fax:
Practice Address - Street 1:4917 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2421
Practice Address - Country:US
Practice Address - Phone:402-556-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3231041C0700X
NE46106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3090OtherMIDLANDS CHOICE PROVIDER
NE82046OtherBLUE CROSS & BLUE SHIELD