Provider Demographics
NPI:1609932649
Name:BOCKOVEN, JERRY NORMAN
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:NORMAN
Last Name:BOCKOVEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2131
Mailing Address - Country:US
Mailing Address - Phone:402-484-0595
Mailing Address - Fax:402-484-6306
Practice Address - Street 1:5350 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2131
Practice Address - Country:US
Practice Address - Phone:402-484-0595
Practice Address - Fax:402-484-6306
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical