Provider Demographics
NPI:1891285458
Name:DIERS, LAINEY MARILYN (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:LAINEY
Middle Name:MARILYN
Last Name:DIERS
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 L ST STE 230
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1732
Mailing Address - Country:US
Mailing Address - Phone:402-512-4296
Mailing Address - Fax:
Practice Address - Street 1:7905 L ST STE 230
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1732
Practice Address - Country:US
Practice Address - Phone:402-512-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-18-55879106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician