Basic Information
| Provider Information | |||||||||
| NPI: | 1881686921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLAMER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | PH D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9922 FLORENCE HEIGHTS BLVD | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681121337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022036317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 S 42ND ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681052947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025527465 | ||||||||
| FaxNumber: | 4025527444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 192 | NE | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.