1699071589 NPI number — JENNIFER E KASSING M.A., PLMHP

Table of content: JENNIFER E KASSING M.A., PLMHP (NPI 1699071589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699071589 NPI number — JENNIFER E KASSING M.A., PLMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSING
Provider First Name:
JENNIFER
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., PLMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699071589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104-3430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-404-1036
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W 29TH ST
Provider Second Line Business Practice Location Address:
SUITE 319
Provider Business Practice Location Address City Name:
SOUTH SIOUX CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68776-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-494-4904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  9331 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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