Individual
MANDY BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
506 E 12TH ST, MC COOK, NE 69001-3599
(308) 745-1530
Mailing address
1111 E 2ND ST, MC COOK, NE 69001-2625
(720) 292-7903
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470563788
—
NE
Enumeration date
02/27/2025
Last updated
02/27/2025
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