Healthcare Provider Details

I. General information

NPI: 1649144288
Provider Name (Legal Business Name): JENNA MARIE KOPERSKI-BOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N COLORADO AVE
FREMONT NE
68025-2286
US

IV. Provider business mailing address

15332 LEAVENWORTH CIR
OMAHA NE
68154-2856
US

V. Phone/Fax

Practice location:
  • Phone: 402-268-1847
  • Fax:
Mailing address:
  • Phone: 402-578-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14981
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: