Provider Demographics
NPI:1588000772
Name:JENNIFER M. PERRY, PH.D., PC
Entity Type:Organization
Organization Name:JENNIFER M. PERRY, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARJORIE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-477-0507
Mailing Address - Street 1:3272 SALT CREEK CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4759
Mailing Address - Country:US
Mailing Address - Phone:402-477-0507
Mailing Address - Fax:402-477-0820
Practice Address - Street 1:3272 SALT CREEK CIR
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4759
Practice Address - Country:US
Practice Address - Phone:402-477-0507
Practice Address - Fax:402-477-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026325700Medicaid