Provider Demographics
NPI:1770470817
Name:HOLLIS, JENNIFER ANNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:HOLLIS
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 1:1035 DIAMOND ST APT 27
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NE
Mailing Address - Zip Code:68038-2707
Mailing Address - Country:US
Mailing Address - Phone:402-870-1564
Mailing Address - Fax:
Practice Address - Street 1:1035 DIAMOND ST APT 27
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NE
Practice Address - Zip Code:68038-2707
Practice Address - Country:US
Practice Address - Phone:402-870-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging