Provider Demographics
NPI:1487984779
Name:ROYER, JERRI
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:
Last Name:ROYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 N 193RD AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13057 W CENTER RD
Practice Address - Street 2:SUITE 25
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3748
Practice Address - Country:US
Practice Address - Phone:402-359-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE96101YA0400X
NE9059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)