Provider Demographics
NPI:1750833794
Name:SVOBODA, JENAE
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:
Last Name:SVOBODA
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 1:1424 1/2 INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-1411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1405 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-3618
Practice Address - Country:US
Practice Address - Phone:308-754-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist