Provider Demographics
NPI:1053118117
Name:LIEN, MARLYN JO
Entity type:Individual
Prefix:
First Name:MARLYN JO
Middle Name:
Last Name:LIEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 S 81ST ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2122
Mailing Address - Country:US
Mailing Address - Phone:402-740-5450
Mailing Address - Fax:
Practice Address - Street 1:410 GALVIN RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4646
Practice Address - Country:US
Practice Address - Phone:402-731-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services