Provider Demographics
NPI:1861772642
Name:JESERITZ, ANNA ELIZABETH (LIMHP, CMSW, LISW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:JESERITZ
Suffix:
Gender:F
Credentials:LIMHP, CMSW, LISW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:RUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5755 SORENSEN PKWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2370
Mailing Address - Country:US
Mailing Address - Phone:402-991-8435
Mailing Address - Fax:
Practice Address - Street 1:5755 SORENSEN PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2370
Practice Address - Country:US
Practice Address - Phone:402-991-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9489101YM0800X
NE2597104100000X
NE1643104100000X
IA007822104100000X
NE1937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA007822OtherSTATE OF IOWA - LISW
NE1643OtherSTATE OF NEBRASKA - CMSW
NE1937OtherSTATE OF NEBRASKA - LIMHP