Individual
JUSTIN LIEDKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6420 S 193RD AVE STE 100, OMAHA, NE 68135-3948
(574) 387-4313
Mailing address
215 RED COACH DR, MISHAWAKA, IN 46545-8307
(574) 387-4313
(574) 204-2868
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
24-373336
NE
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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