Basic Information
| Provider Information | |||||||||
| NPI: | 1801225230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RATHJE | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | JOANN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | NCC, LIMHP, CADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAULSON | ||||||||
| OtherFirstName: | JACLYN | ||||||||
| OtherMiddleName: | JOANN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 917 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH SIOUX CITY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687762652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024943337 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 917 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH SIOUX CITY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687762652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024943337 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2013 | ||||||||
| LastUpdateDate: | 11/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1185 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.