=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457869133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMI BLOMSTEDT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2018
-----------------------------------------------------
Last Update Date | 01/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 N COTNER BLVD STE 330
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68505-2377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-417-0957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 N COTNER BLVD STE 330
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68505-2377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-417-0957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/OWNER
-----------------------------------------------------
Name | JAMI BLOMSTEDT
-----------------------------------------------------
Credential | LIMHP
-----------------------------------------------------
Telephone | 402-417-0957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------