Individual
MS. MARY KATHLEEN MIKLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC/SLP
Contact information
Practice address
4010 N 104TH PLZ, OMAHA, NE 68134-3762
(402) 431-0397
Mailing address
4010 N 104TH PLZ, OMAHA, NE 68134-3762
(402) 431-0397
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
549
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09225
BCBS PROVIDER NUMBER
NE
01
—
11188466
MULTIPLAN PROVIDER NUMBER
NE
01
—
549
SPEECH/LANGUAGE LICENSE
NE
Enumeration date
10/23/2006
Last updated
07/08/2007
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