Provider Demographics
NPI:1184054215
Name:GREEN, JANA MAREE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:MAREE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S LOGAN AVE
Mailing Address - Street 2:123 NORTH MINDEN AVENUE
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1844
Mailing Address - Country:US
Mailing Address - Phone:308-832-2460
Mailing Address - Fax:
Practice Address - Street 1:447 S LOGAN AVE
Practice Address - Street 2:123 NORTH MINDEN AVENUE
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1844
Practice Address - Country:US
Practice Address - Phone:308-832-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE01092759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist