Provider Demographics
NPI:1124679196
Name:BILSTEIN, JEANETTE ELAINE (MA)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELAINE
Last Name:BILSTEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:ELAINE
Other - Last Name:BILSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1609 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-1218
Mailing Address - Country:US
Mailing Address - Phone:402-480-9604
Mailing Address - Fax:
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3340
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY101YP2500XMedicaid