Provider Demographics
NPI:1952441735
Name:SUKUP, JENNIFER (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SUKUP
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N DEWEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3928
Mailing Address - Country:US
Mailing Address - Phone:308-660-3257
Mailing Address - Fax:800-616-0783
Practice Address - Street 1:516 N DEWEY ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3928
Practice Address - Country:US
Practice Address - Phone:308-660-3257
Practice Address - Fax:800-616-0783
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE926101YA0400X
NE2734101YM0800X
NE797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)