Provider Demographics
NPI:1588460240
Name:SOUDER, JESSICA C
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:SOUDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:C
Other - Last Name:ASHBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSICA SHOEMAKER
Mailing Address - Street 1:14856 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2063
Mailing Address - Country:US
Mailing Address - Phone:402-676-9976
Mailing Address - Fax:
Practice Address - Street 1:14856 SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2063
Practice Address - Country:US
Practice Address - Phone:402-676-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities