Detwieler, Jody L

Detwieler, Jody L is an individual health care provider with primary practice located at 2608 Old Fair Rd , Grand Island NE 68803-5271. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Detwieler, Jody L can be contacted via phone (308) 382-5297.

Contact Information

Primary practice address
2608 Old Fair Rd Grand Island NE 68803-5271
Phone: (308) 382-5297
Fax: (308) 382-5315
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2006022486 Missouri

Profile Details

NPI number 1962622746
LBN Legal business name Detwieler, Jody L
Credentials LIMHP, LCSW
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2007
Last updated Apr 12th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962622746 NPPES
Nebraska MEDICAID 10025173100

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