Provider Demographics
NPI:1780935569
Name:ANTHOLZ, JENNIFER L
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ANTHOLZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-0406
Mailing Address - Country:US
Mailing Address - Phone:308-754-4421
Mailing Address - Fax:308-754-2303
Practice Address - Street 1:1113 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-1546
Practice Address - Country:US
Practice Address - Phone:308-754-4421
Practice Address - Fax:308-754-2303
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE13231OtherPROVISIONAL MENTAL HEALTH PRACTITIONER