Provider Demographics
NPI:1457656829
Name:ECKERMAN, JILL DIANE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:DIANE
Last Name:ECKERMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15733 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2105
Mailing Address - Country:US
Mailing Address - Phone:402-657-3700
Mailing Address - Fax:
Practice Address - Street 1:11909 ARBOR ST STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4418
Practice Address - Country:US
Practice Address - Phone:402-708-7597
Practice Address - Fax:402-625-0455
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE520101YA0400X
NE846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)