Healthcare Provider Details

I. General information

NPI: 1053147652
Provider Name (Legal Business Name): JORDAN JUDITH HENKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 GLYNOAKS DR STE 180
LINCOLN NE
68516-6378
US

IV. Provider business mailing address

8230 RENATTA DR APT 6311
LINCOLN NE
68516-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-817-2116
  • Fax:
Mailing address:
  • Phone: 402-239-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14041
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: