MEDICARE: MS. JORDYN LEA KEASLING LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2756	NE
2	1041C0700X	Clinical Social Worker	7103	NE
3	101YM0800X	Mental Health Counselor	11016	NE

General Provider Information

NPI Number	:	1235665886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JORDYN LEA KEASLING LCSW

Provider Business Mailing Address
First Line	:	835 S BURLINGTON AVE STE 108
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-6928
Country	:	US
Telephone Number	:	402-463-7711
Fax Number	:	402-460-5829

Provider Business Practice Location Address
First Line	:	835 S BURLINGTON AVE STE 108
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-6928
Country	:	US
Telephone Number	:	402-463-7711
Fax Number	:	402-460-5829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	10/16/2018

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