Provider Demographics
NPI:1699071589
Name:KASSING, JENNIFER E (MA, PLMHP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:KASSING
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3430
Mailing Address - Country:US
Mailing Address - Phone:402-404-1036
Mailing Address - Fax:
Practice Address - Street 1:1000 W 29TH ST
Practice Address - Street 2:SUITE 319
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3852
Practice Address - Country:US
Practice Address - Phone:402-494-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health