Individual
JACLYN GREVENGOED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
13616 CALIFORNIA ST STE 100, OMAHA, NE 68154-5336
(402) 496-0404
Mailing address
7505 COUNTRY CLUB DR, GOLDEN VALLEY, MN 55427-4501
(763) 450-6902
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3922
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47081304012
—
NE
Enumeration date
11/23/2013
Last updated
09/11/2023
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