Healthcare Provider Details

I. General information

NPI: 1700790854
Provider Name (Legal Business Name): JESSICA LYNN PLOEN PLMHP, PLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 CAMDEN AVE
OMAHA NE
68134-2648
US

IV. Provider business mailing address

9405 CAMDEN AVE
OMAHA NE
68134-2648
US

V. Phone/Fax

Practice location:
  • Phone: 402-915-1653
  • Fax:
Mailing address:
  • Phone: 402-915-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2461
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15053
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: