Healthcare Provider Details

I. General information

NPI: 1750988325
Provider Name (Legal Business Name): MELISSA ANN JANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MISSION MIDDLE SCHOOL
BELLEVUE NE
68005
US

IV. Provider business mailing address

8420 S 64TH ST
OMAHA NE
68157-2138
US

V. Phone/Fax

Practice location:
  • Phone: 402-577-0095
  • Fax:
Mailing address:
  • Phone: 785-643-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number12138
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: