Provider Demographics
NPI:1902446024
Name:MCSHANE-JEWELL, PATRICE (MSW, PLMHP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:MCSHANE-JEWELL
Suffix:
Gender:F
Credentials:MSW, PLMHP
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:MCSHANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, PLMHP
Mailing Address - Street 1:1650 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2609
Mailing Address - Country:US
Mailing Address - Phone:402-802-1549
Mailing Address - Fax:
Practice Address - Street 1:1100 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4812
Practice Address - Country:US
Practice Address - Phone:402-436-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72801041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool