Provider Demographics
NPI:1770688657
Name:WATSON, JANE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JANIE
Other - Middle Name:
Other - Last Name:PFEIFER-WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2608 OLD FAIR RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5271
Mailing Address - Country:US
Mailing Address - Phone:308-382-5297
Mailing Address - Fax:308-382-5315
Practice Address - Street 1:2608 OLD FAIR RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5271
Practice Address - Country:US
Practice Address - Phone:308-382-5297
Practice Address - Fax:308-382-5315
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE810101YM0800X
NE6601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1124130364OtherNPI FOR CORPORATION
NE10025173100Medicaid
NE10025173100Medicaid