Provider Demographics
NPI:1417327990
Name:FRY, JENNIFER KAY (MA PLMHP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KAY
Last Name:FRY
Suffix:
Gender:F
Credentials:MA PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S 9TH ST STE 126
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2282
Mailing Address - Country:US
Mailing Address - Phone:402-430-0364
Mailing Address - Fax:
Practice Address - Street 1:421 S 9TH ST STE 126
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2282
Practice Address - Country:US
Practice Address - Phone:402-430-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470398819Medicaid