Provider Demographics
NPI:1053945477
Name:LINN, SHAYLA
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:LINN
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 1:2828 REED LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7949
Mailing Address - Country:US
Mailing Address - Phone:402-719-7318
Mailing Address - Fax:
Practice Address - Street 1:1750 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3206
Practice Address - Country:US
Practice Address - Phone:402-941-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool