Provider Demographics
NPI:1336936236
Name:WIEZOREK, DEBORAH J
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:WIEZOREK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1063
Mailing Address - Country:US
Mailing Address - Phone:402-515-7449
Mailing Address - Fax:
Practice Address - Street 1:5436 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1063
Practice Address - Country:US
Practice Address - Phone:402-515-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging