Provider Demographics
NPI:1285274837
Name:HAGEDORN, AMANDA ROCHELLE (PLMHP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROCHELLE
Last Name:HAGEDORN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6456 N 107TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1190
Mailing Address - Country:US
Mailing Address - Phone:402-213-0439
Mailing Address - Fax:
Practice Address - Street 1:955 N ADAMS ST STE 8
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3080
Practice Address - Country:US
Practice Address - Phone:531-444-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health