Provider Demographics
NPI:1730191644
Name:OSBORNE, JERAD LEE (LCSW)
Entity type:Individual
Prefix:
First Name:JERAD
Middle Name:LEE
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13548 DISCOVERY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3003
Mailing Address - Country:US
Mailing Address - Phone:402-309-3941
Mailing Address - Fax:
Practice Address - Street 1:13548 DISCOVERY DR
Practice Address - Street 2:SUITE B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3003
Practice Address - Country:US
Practice Address - Phone:402-309-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 75391041C0700X
NE1928101YM0800X
NE4071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766271800Medicaid