Provider Demographics
NPI:1831437037
Name:AESOPH, JENNIFER ANN (MA, LIMHP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:AESOPH
Suffix:
Gender:F
Credentials:MA, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 S 96TH ST STE 258
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1244
Mailing Address - Country:US
Mailing Address - Phone:402-214-4344
Mailing Address - Fax:402-275-6958
Practice Address - Street 1:4611 S 96TH ST STE 258
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1244
Practice Address - Country:US
Practice Address - Phone:402-214-4344
Practice Address - Fax:402-275-6958
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1395OtherLIMHP