Provider Demographics
NPI:1528278157
Name:MIKOLOYCK, SHEENA MARIE (MS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:MARIE
Last Name:MIKOLOYCK
Suffix:
Gender:F
Credentials:MS PSYCHOLOGY
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:MARIE
Other - Last Name:WESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PSYCHOLOGY
Mailing Address - Street 1:511 N D ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5051
Mailing Address - Country:US
Mailing Address - Phone:402-720-6853
Mailing Address - Fax:402-727-0779
Practice Address - Street 1:511 N D ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5051
Practice Address - Country:US
Practice Address - Phone:402-720-6853
Practice Address - Fax:402-727-0779
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3801101YM0800X
NE4745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE600931841Medicaid
NE13808662OtherCAQH