Basic Information
Provider Information
NPI: 1104083237
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEHLER
FirstName: JODI
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: MSW, LMHP, CMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4545 S 86TH ST
Address2:  
City: LINCOLN
State: NE
PostalCode: 685269227
CountryCode: US
TelephoneNumber: 4024836990
FaxNumber:  
Practice Location
Address1: 4545 S 86TH ST
Address2:  
City: LINCOLN
State: NE
PostalCode: 685269227
CountryCode: US
TelephoneNumber: 4024836990
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2008
LastUpdateDate: 11/26/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X1095NEN Behavioral Health & Social Service ProvidersCounselorMental Health
1041C0700X1366NEY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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