Provider Demographics
NPI:1902818172
Name:HENNESSY-KEIMIG, JEANNE KATHERINE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:KATHERINE
Last Name:HENNESSY-KEIMIG
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:KATHERINE
Other - Last Name:HENNESSY-KEIMIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:19804 MARINDA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-3006
Mailing Address - Country:US
Mailing Address - Phone:507-828-5231
Mailing Address - Fax:
Practice Address - Street 1:2126 N 117TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3670
Practice Address - Country:US
Practice Address - Phone:402-934-1617
Practice Address - Fax:402-934-5228
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE981103TC0700X, 103TC1900X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN172108OtherUCARE
MN50M13HEOtherBLUE CROSS BLUE SHIELD
MNHP34128OtherHEALTH PARTNERS
MN1032342OtherPREFERRED ONE
MN20621OtherSIOUX VALLEY HEALTH
MN61-55417OtherMEDICA
MN2503815/2281375OtherUNITED HEALTH CARE
MN355400700Medicaid
MN355400700Medicaid
MN680002604Medicare PIN