MEDICARE: JENNIFER E KASSING M.A., PLMHP

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	9331	NE

General Provider Information

NPI Number	:	1699071589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER E KASSING M.A., PLMHP

Provider Business Mailing Address
First Line	:	1915 JACKSON ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3430
Country	:	US
Telephone Number	:	402-404-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W 29TH ST
Second Line	:	SUITE 319
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3852
Country	:	US
Telephone Number	:	402-494-4904
Fax Number	:

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

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	02/10/2011

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