Individual
MS. BRENDA JEAN BASSINGTHWAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
444 S 44TH ST, OMAHA, NE 68131-3727
(402) 559-6408
(402) 559-5737
Mailing address
985450 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-5450
(402) 559-6408
(402) 559-5737
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
001146
IA
103T00000X
Psychologist
Primary
1014
NE
103TB0200X
Cognitive & Behavioral Psychologist
001146
IA
103TC2200X
Clinical Child & Adolescent Psychologist
001146
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0459529
—
IA
01
—
31342
UNKNOWN
IA
01
—
I8112
MEDICARE ID-TYPE UNSPECIFIED
IA
Enumeration date
05/04/2011
Last updated
08/31/2020
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