Provider Demographics
NPI:1104662634
Name:TROVATO, JENNIFER (PLMHP PLADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TROVATO
Suffix:
Gender:F
Credentials:PLMHP PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 S 161ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2952
Mailing Address - Country:US
Mailing Address - Phone:402-578-2286
Mailing Address - Fax:
Practice Address - Street 1:4565 S 133RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1142
Practice Address - Country:US
Practice Address - Phone:402-590-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health