Provider Demographics
NPI:1578368296
Name:GLENN, JENNIFER LYNN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:GLENN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:STROTHKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1509 ROAD I
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68354-4051
Mailing Address - Country:US
Mailing Address - Phone:402-759-1267
Mailing Address - Fax:
Practice Address - Street 1:1509 ROAD I
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NE
Practice Address - Zip Code:68354-4051
Practice Address - Country:US
Practice Address - Phone:402-759-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician