| Jessica Grossnicklaus, Psyd, Llc | |
|
2001 Pine Lake Rd Ste 200 Lincoln NE 68512-3604 | |
| (402) 261-8313 | |
| Not Available |
| Full Name | Jessica Grossnicklaus, Psyd, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2001 Pine Lake Rd Ste 200, Lincoln, Nebraska |
| Authorized Official Name and Position | Jessica Grossnicklaus (PSYCHOLOGIST) |
| Authorized Official Contact | 3082891026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Grossnicklaus, Psyd, Llc 2001 Pine Lake Rd Ste 200 Lincoln NE 68512-3604 Ph: (308) 289-1026 | Jessica Grossnicklaus, Psyd, Llc 2001 Pine Lake Rd Ste 200 Lincoln NE 68512-3604 Ph: (402) 261-8313 |
| NPI Number | 1700534799 |
|---|---|
| Provider Enumeration Date | 03/17/2022 |
| Last Update Date | 08/09/2023 |
| Certification Date | 08/09/2023 |
| Medicare PECOS PAC ID | 0244627305 |
|---|---|
| Medicare Enrollment ID | O20220420001934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700534799 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jessica Grossnicklaus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881242691 PECOS PAC ID: 0446647010 Enrollment ID: I20220429000220 |
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