Provider Demographics
NPI:1215911656
Name:RHODES, JACQUELINE KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:KAY
Last Name:RHODES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 N 269TH CIR
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-4435
Mailing Address - Country:US
Mailing Address - Phone:402-504-4101
Mailing Address - Fax:
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:STE 402
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-483-4215
Practice Address - Fax:402-483-5228
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE436103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5906OtherMIDLANDS CHOICE
NE620005771OtherRAILROAD MEDICARE
NE777645000Medicaid
NE08002OtherBCBS
NE620005771OtherRAILROAD MEDICARE