Provider Demographics
NPI:1578766143
Name:MCQUILLEN, JODI LYNN (LIMHP, LCSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:MCQUILLEN
Suffix:
Gender:F
Credentials:LIMHP, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1520
Practice Address - Country:US
Practice Address - Phone:402-575-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0068331041C0700X
NE3448101YM0800X
NE753101YM0800X
NE13031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100258639-00Medicaid
NENA1591OtherMEDICARE PTAN