Provider Demographics
NPI:1841373826
Name:ECKHOUT, JENNIFER LYNNE (MS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:ECKHOUT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3409 B ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4519
Mailing Address - Country:US
Mailing Address - Phone:402-416-4444
Mailing Address - Fax:
Practice Address - Street 1:1617 NORMANDY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1474
Practice Address - Country:US
Practice Address - Phone:402-416-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84709OtherBLUE CROSS BLUE SHIELD
NE246505OtherMIDLANDS CHOICE