Provider Demographics
NPI:1649258435
Name:LEPARD, JENINA SHAW (LICSW)
Entity type:Individual
Prefix:MS
First Name:JENINA
Middle Name:SHAW
Last Name:LEPARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 BROWNING ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2936
Mailing Address - Country:US
Mailing Address - Phone:402-770-9378
Mailing Address - Fax:
Practice Address - Street 1:4120 BROWNING ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2936
Practice Address - Country:US
Practice Address - Phone:402-770-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1240 LMHP1041C0700X
NE743 CMSW1041C0700X
NE751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91176468226Medicaid
NEUNITY1909Medicare UPIN
NE268716Medicare ID - Type Unspecified