Provider Demographics
NPI:1194055087
Name:JACKSON, JENNIFER JO-JIVIDEN (LIMHP, LMHP, LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO-JIVIDEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LIMHP, LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-0355
Mailing Address - Country:US
Mailing Address - Phone:402-494-3337
Mailing Address - Fax:402-494-3356
Practice Address - Street 1:1201 ARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-6877
Practice Address - Country:US
Practice Address - Phone:402-494-3337
Practice Address - Fax:402-494-3356
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8988101YM0800X
NE3842101YM0800X
NE1904101YP2500X
NE919101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional