Provider Demographics
NPI:1467952713
Name:SEGOVIANO, JESSICA RUTH (PLADC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RUTH
Last Name:SEGOVIANO
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:RUTH
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2939
Mailing Address - Country:US
Mailing Address - Phone:402-504-3242
Mailing Address - Fax:402-504-3882
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-504-3242
Practice Address - Fax:402-504-3882
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
NEP-1550101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)