MEDICARE: DR. THERESA JENKINS-CHADWICK PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14743	NE

General Provider Information

NPI Number	:	1447117551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA JENKINS-CHADWICK PSYD

Provider Business Mailing Address
First Line	:	4309 S 179TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-3653
Country	:	US
Telephone Number	:	218-296-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 S 179TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-3653
Country	:	US
Telephone Number	:	218-296-3399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	02/04/2026

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