Individual
ANGELA MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
7721 S 71ST ST, LA VISTA, NE 68128-3011
(402) 515-4782
Mailing address
7721 S 71ST ST, LA VISTA, NE 68128-3011
(402) 515-4782
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1328
NE
Other
Enumeration date
10/13/2014
Last updated
10/13/2014
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