Provider Demographics
NPI:1548731755
Name:CORDER, JAMIE NICOLE (PLADC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:NICOLE
Last Name:CORDER
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:NICOLE
Other - Last Name:GILLISPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 SKYWAY RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2631
Mailing Address - Country:US
Mailing Address - Phone:402-327-6821
Mailing Address - Fax:402-483-4594
Practice Address - Street 1:4600 VALLEY RD STE 223
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4892
Practice Address - Country:US
Practice Address - Phone:402-327-6821
Practice Address - Fax:402-483-4594
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1613101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)