Healthcare Provider Details

I. General information

NPI: 1235022484
Provider Name (Legal Business Name): JAMIE ANN WREDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11717 S 216TH ST
GRETNA NE
68028-4729
US

IV. Provider business mailing address

15360 ORCHARD AVE
OMAHA NE
68137-5008
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-3265
  • Fax:
Mailing address:
  • Phone: 402-670-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6358
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4192
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20230000594
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: