Provider Demographics
NPI:1932288347
Name:JESSEN, ELIZABETH L (LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:L
Last Name:JESSEN
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3201 PIONEERS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-489-9959
Mailing Address - Fax:402-489-2219
Practice Address - Street 1:3201 PIONEERS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-489-9959
Practice Address - Fax:402-489-2219
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026634000Medicaid