Provider Demographics
NPI:1689121576
Name:KNIEVEL, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KNIEVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:NE
Mailing Address - Zip Code:68031-1259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2163 COUNTY ROAD G
Practice Address - Street 2:
Practice Address - City:HOOPER
Practice Address - State:NE
Practice Address - Zip Code:68031-1259
Practice Address - Country:US
Practice Address - Phone:402-654-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2013007192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470523755Medicaid