Provider Demographics
NPI:1881167138
Name:WILBUR, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:WILBUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 L ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-1902
Mailing Address - Country:US
Mailing Address - Phone:402-694-3167
Mailing Address - Fax:402-694-5348
Practice Address - Street 1:300 L ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-1902
Practice Address - Country:US
Practice Address - Phone:402-694-3167
Practice Address - Fax:402-694-5348
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2015001913103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool