Individual
MRS. JESSICA MIRANDA LUPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDS
Contact information
Practice address
615 PIEDMONT DR, OMAHA, NE 68154-2731
(402) 715-1390
Mailing address
5506 SOUTH 147TH STREET, OMAHA, NE 68137
(402) 715-1390
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098080A
—
KS
01
—
100098080C
SED WAIVER
KS
Enumeration date
07/22/2008
Last updated
11/14/2025
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