Healthcare Provider Details

I. General information

NPI: 1366169773
Provider Name (Legal Business Name): JORDYN TEAL SCHNABEL HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 W BROADWAY STE 100B
COUNCIL BLUFFS IA
51501-3291
US

IV. Provider business mailing address

9015 ARBOR ST STE 118
OMAHA NE
68124-2056
US

V. Phone/Fax

Practice location:
  • Phone: 402-616-5482
  • Fax:
Mailing address:
  • Phone: 402-616-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number090599
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: