Provider Demographics
NPI:1043710320
Name:PATTEE, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:PATTEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:NE
Mailing Address - Zip Code:68741-3084
Mailing Address - Country:US
Mailing Address - Phone:712-389-6475
Mailing Address - Fax:
Practice Address - Street 1:2116 A ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3028
Practice Address - Country:US
Practice Address - Phone:712-389-6475
Practice Address - Fax:712-389-6475
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool