Provider Demographics
NPI:1376225235
Name:SELL-GROVE, JODI R
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:R
Last Name:SELL-GROVE
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 1:145 N HASTINGS
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:NE
Mailing Address - Zip Code:68815-6005
Mailing Address - Country:US
Mailing Address - Phone:308-789-6510
Mailing Address - Fax:
Practice Address - Street 1:145 N HASTINGS
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:NE
Practice Address - Zip Code:68815-6005
Practice Address - Country:US
Practice Address - Phone:308-789-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health