Provider Demographics
NPI:1720754583
Name:SEEDE, JENNINE MERRIAM
Entity Type:Individual
Prefix:
First Name:JENNINE
Middle Name:MERRIAM
Last Name:SEEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 COUNCIL ST NE STE 117
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5860
Mailing Address - Country:US
Mailing Address - Phone:319-423-0919
Mailing Address - Fax:319-382-2488
Practice Address - Street 1:5925 COUNCIL ST NE STE 117
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5860
Practice Address - Country:US
Practice Address - Phone:319-423-0919
Practice Address - Fax:319-382-2488
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)