Healthcare Provider Details

I. General information

NPI: 1053018697
Provider Name (Legal Business Name): JONATHAN FREDERICK WHITEHEAD LIMHP, CMSW, PLDAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 VICTORY PARK DR
LINCOLN NE
68510-2484
US

IV. Provider business mailing address

420 VICTORY PARK DR
LINCOLN NE
68510-2484
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-4927
  • Fax: 612-725-1058
Mailing address:
  • Phone: 402-937-4927
  • Fax: 612-725-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4163
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: