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Individual

LISA K VAN WINKLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PLADC

Contact information

Practice address
4110 AVENUE D, SCOTTSBLUFF, NE 69361-4650
(308) 635-3171
Mailing address
4110 AVENUE D, SCOTTSBLUFF, NE 69361-4650

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-1439
NE
104100000X
Social Worker

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
47051963312
NE
Enumeration date
10/04/2013
Last updated
10/17/2016
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