Provider Demographics
NPI:1245505775
Name:BARTAK-JENSEN, BROOKE ELIZABETH (LIMHP)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:BARTAK-JENSEN
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 NICHOLAS ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2188
Mailing Address - Country:US
Mailing Address - Phone:402-957-2759
Mailing Address - Fax:
Practice Address - Street 1:10020 NICHOLAS ST STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2188
Practice Address - Country:US
Practice Address - Phone:402-957-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470398819Medicaid