MEDICARE: JERE LOHSE

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1740646058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERE LOHSE

Provider Business Mailing Address
First Line	:	9485 PAULINE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3838
Country	:	US
Telephone Number	:	402-707-4947
Fax Number	:

Provider Business Practice Location Address
First Line	:	9485 PAULINE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3838
Country	:	US
Telephone Number	:	402-707-4947
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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Directions to “ JERE LOHSE ” Practice Location

Language	Start Address	Practice Location

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