Healthcare Provider Details

I. General information

NPI: 1780935569
Provider Name (Legal Business Name): JENNIFER L ANTHOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 SHERMAN ST
SAINT PAUL NE
68873-1546
US

IV. Provider business mailing address

PO BOX 406
SAINT PAUL NE
68873-0406
US

V. Phone/Fax

Practice location:
  • Phone: 308-754-4421
  • Fax: 308-754-2303
Mailing address:
  • Phone: 308-754-4421
  • Fax: 308-754-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9760
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: