Basic Information
| Provider Information | |||||||||
| NPI: | 1659926269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISKE | ||||||||
| FirstName: | JENNI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17030 LAKESIDE HILLS PLZ STE 204 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681302396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027585600 | ||||||||
| FaxNumber: | 4027585165 | ||||||||
| Practice Location | |||||||||
| Address1: | 7710 MERCY RD STE 3000 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027585600 | ||||||||
| FaxNumber: | 4027585165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2019 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 382 | NE | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.