Provider Demographics
NPI:1396294302
Name:JERKE, JORDAN (LIMHP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:JERKE
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:MOLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP
Mailing Address - Street 1:115 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3368
Mailing Address - Country:US
Mailing Address - Phone:308-760-5774
Mailing Address - Fax:
Practice Address - Street 1:115 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3368
Practice Address - Country:US
Practice Address - Phone:308-760-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5248101YM0800X
NE2623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health