Provider Demographics
NPI:1558113530
Name:BLASE, VALERIE LYNN (PLMHP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:BLASE
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:LYNN
Other - Last Name:ARDUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 W PASEWALK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5657
Mailing Address - Country:US
Mailing Address - Phone:402-500-6870
Mailing Address - Fax:402-500-6871
Practice Address - Street 1:3805 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2233
Practice Address - Country:US
Practice Address - Phone:402-500-6870
Practice Address - Fax:402-500-6871
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE14047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program