Provider Demographics
NPI:1528145323
Name:PERRY, JENNIFER MARJORIE (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARJORIE
Last Name:PERRY
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 1:3272 SALT CREEK CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504
Mailing Address - Country:US
Mailing Address - Phone:402-477-0507
Mailing Address - Fax:402-477-0820
Practice Address - Street 1:3272 SALT CREEK CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504
Practice Address - Country:US
Practice Address - Phone:402-477-0507
Practice Address - Fax:402-477-0820
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026325700Medicaid