Provider Demographics
NPI:1659838886
Name:SMITH, JESSICA JO (LIMHP, CMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:LIMHP, CMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JO
Other - Last Name:FRENZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12127 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12127 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3527
Practice Address - Country:US
Practice Address - Phone:308-210-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11613101YM0800X
NE3312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty