Provider Demographics
NPI:1558400697
Name:WERTZ, JILL KRISTINE (MA LIMHP LADC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:KRISTINE
Last Name:WERTZ
Suffix:
Gender:F
Credentials:MA LIMHP LADC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KRISTINE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3701 UNION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6629
Mailing Address - Country:US
Mailing Address - Phone:402-875-9270
Mailing Address - Fax:402-875-9272
Practice Address - Street 1:3701 UNION DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6629
Practice Address - Country:US
Practice Address - Phone:402-875-9270
Practice Address - Fax:402-875-9272
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE378101YM0800X
NE395101YM0800X
NE2205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE239596OtherMIDLANDS CHOICE
NE85190OtherBCBS