Healthcare Provider Details

I. General information

NPI: 1497571160
Provider Name (Legal Business Name): JENIFER DESROSIERS PLADC, PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S 70TH ST STE 105
LINCOLN NE
68510-7901
US

IV. Provider business mailing address

1001 S 70TH ST STE 105
LINCOLN NE
68510-7901
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-4343
  • Fax:
Mailing address:
  • Phone: 402-474-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2234
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4704
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: