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Alison Defrance Widtfeldt

Counselor

Behavioral Health & Social Service Providers

11920 Burt St Ste 190, Omaha, NE 68154-1573

PECOS Enrollment

Based on the most recent information from CMS, provider Alison Defrance Widtfeldt is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 10:51 AM.

Profile Details

Provider ID
1457763138
Provider Type
Individual
Full Name
Defrance Widtfeldt, Alison
Gender
Female

Sole Proprietor
No
Enumeration Date
5/29/2014
Last Updated
9/23/2015

Contact Information

Practice Location

11920 Burt St Ste 190, Omaha, NE 68154-1573

(402) 965-4004

Unlisted Fax

Mailing Location

721 Redwood Dr, Council Bluffs, IA 51503-8479

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 4607 Nebraska
Code 101YM0800X	Description Counselor Behavioral Health & Social Service Providers	License 001358 Iowa
Code 101YP2500X	Description Counselor Behavioral Health & Social Service Providers	License 2235 Nebraska

Alison Defrance Widtfeldt

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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License

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