Healthcare Provider Details

I. General information

NPI: 1053670521
Provider Name (Legal Business Name): JESSICA MAHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W 21ST ST
SOUTH SIOUX CITY NE
68776-2652
US

IV. Provider business mailing address

917 W 21ST ST
SOUTH SIOUX CITY NE
68776-2652
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-3337
  • Fax: 402-494-3356
Mailing address:
  • Phone: 402-494-3337
  • Fax: 402-494-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: