Provider Demographics
NPI:1205970787
Name:NESTELL/NIELSEN, JENNIFER LEE (PHD MSW LICSW LSCSW)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:NESTELL/NIELSEN
Suffix:
Gender:F
Credentials:PHD MSW LICSW LSCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:MEDGYESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW, LICSW
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-0613
Mailing Address - Country:US
Mailing Address - Phone:913-242-5444
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-1884
Practice Address - Country:US
Practice Address - Phone:913-242-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160306921041C0700X
KS42971041C0700X
CALCS229071041C0700X
NH20481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I803235Medicare PIN
TN1529090Medicaid