Provider Demographics
NPI:1326682592
Name:DEGNER, ANDREA DAWN (LIMHP, LMHP, LICSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:DEGNER
Suffix:
Gender:F
Credentials:LIMHP, LMHP, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-4342
Mailing Address - Country:US
Mailing Address - Phone:402-432-8311
Mailing Address - Fax:
Practice Address - Street 1:11605 MIRACLE HILLS DR STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4467
Practice Address - Country:US
Practice Address - Phone:402-238-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5334101YM0800X
NE1841104100000X
NE3648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker