Provider Demographics
NPI:1174321533
Name:OUEDRAOGO, DJIBRIL
Entity type:Individual
Prefix:
First Name:DJIBRIL
Middle Name:
Last Name:OUEDRAOGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N 55TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3534
Mailing Address - Country:US
Mailing Address - Phone:862-452-3924
Mailing Address - Fax:
Practice Address - Street 1:3131 N 55TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3534
Practice Address - Country:US
Practice Address - Phone:862-452-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker