Provider Demographics
NPI:1720825649
Name:FLEMING, ELIZABETH ROSEANNA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSEANNA
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:ROSEANNA
Other - Last Name:ACKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4815 S 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1904
Mailing Address - Country:US
Mailing Address - Phone:402-455-0808
Mailing Address - Fax:
Practice Address - Street 1:4815 S 107TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1904
Practice Address - Country:US
Practice Address - Phone:402-455-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health