Individual
JENNIFER LYNN WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., PLMHP
Contact information
Practice address
5115 F ST, OMAHA, NE 68117-2807
(402) 397-9866
Mailing address
13312 JAYNES PLZ APT 105, OMAHA, NE 68164-1059
(402) 520-5456
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9211
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470765107
—
NE
Enumeration date
08/19/2010
Last updated
08/19/2010
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