Provider Demographics
NPI:1053147652
Name:HENKEL, JORDAN JUDITH
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JUDITH
Last Name:HENKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 RENATTA DR APT 6311
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5248
Mailing Address - Country:US
Mailing Address - Phone:402-239-0328
Mailing Address - Fax:
Practice Address - Street 1:8333 GLYNOAKS DR STE 180
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6378
Practice Address - Country:US
Practice Address - Phone:402-817-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health