Provider Demographics
NPI:1285362178
Name:SKRADSKI, MARIAH LEI (LADC)
Entity type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:LEI
Last Name:SKRADSKI
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2103
Mailing Address - Country:US
Mailing Address - Phone:402-871-1997
Mailing Address - Fax:
Practice Address - Street 1:3218 W VAN DORN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-9278
Practice Address - Country:US
Practice Address - Phone:402-479-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1526101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)