Provider Demographics
NPI:1275525339
Name:EGAN, JACQUELINE J (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:EGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5165
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-0165
Mailing Address - Country:US
Mailing Address - Phone:402-435-6111
Mailing Address - Fax:402-486-1548
Practice Address - Street 1:1327 H ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-3751
Practice Address - Country:US
Practice Address - Phone:402-435-6111
Practice Address - Fax:402-486-1548
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP 4961041C0700X
NECMSW771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82389OtherBCBS
NE82389OtherBCBS