Individual
MRS. JODI LYNN MCQUILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIMHP, LCSW, LISW
Contact information
Practice address
2510 BELLEVUE MEDICAL CENTER DR, SUITE 200, BELLEVUE, NE 68123-1520
(402) 575-2275
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3448
NE
101YM0800X
Mental Health Counselor
Primary
753
NE
1041C0700X
Clinical Social Worker
006833
IA
1041C0700X
Clinical Social Worker
1303
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100258639-00
—
NE
01
—
NA1591
MEDICARE PTAN
NE
Enumeration date
06/08/2007
Last updated
02/22/2017
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