Provider Demographics
NPI:1942925946
Name:BROEDER, JAKELYNN (PLMHP, PLCSW)
Entity Type:Individual
Prefix:
First Name:JAKELYNN
Middle Name:
Last Name:BROEDER
Suffix:
Gender:F
Credentials:PLMHP, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W 39TH ST APT 34
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1234
Mailing Address - Country:US
Mailing Address - Phone:308-353-1278
Mailing Address - Fax:
Practice Address - Street 1:5308 PARKLANE DR
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8630
Practice Address - Country:US
Practice Address - Phone:308-251-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health