Individual
JODY L DETWIELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LIMHP, LCSW
Contact information
Practice address
2608 OLD FAIR RD, GRAND ISLAND, NE 68803-5271
(308) 382-5297
(308) 382-5315
Mailing address
2608 OLD FAIR RD, GRAND ISLAND, NE 68803-5271
(308) 382-5297
(308) 382-5315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
2006022486
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025173100
—
NE
Enumeration date
04/26/2007
Last updated
04/12/2021
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