Provider Demographics
NPI:1427435254
Name:IKE, AMANDA (LMHP, CMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:IKE
Suffix:
Gender:F
Credentials:LMHP, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 S 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3042
Mailing Address - Country:US
Mailing Address - Phone:701-580-0662
Mailing Address - Fax:701-857-0763
Practice Address - Street 1:3031 S 87TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3042
Practice Address - Country:US
Practice Address - Phone:701-580-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4570104100000X
NE110741041C0700X
NE53911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker