Provider Demographics
NPI:1316107238
Name:SHANLE, AMBER (CTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SHANLE
Suffix:
Gender:F
Credentials:CTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 23 ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-564-9888
Mailing Address - Fax:402-564-9899
Practice Address - Street 1:5124 23 ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-564-9888
Practice Address - Fax:402-564-9899
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025268300Medicaid