Basic Information
| Provider Information | |||||||||
| NPI: | 1932516762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILLEMUTH | ||||||||
| FirstName: | GAIL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 S 24TH ST | ||||||||
| Address2: | #230 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681021226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029785673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 S 24TH ST | ||||||||
| Address2: | #100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681021213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023427007 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2014 | ||||||||
| LastUpdateDate: | 07/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1965 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 927 | NE | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.