Active NPI
Jennifer Norie Moniz Tevlin, PH.D.
- Psychologist
- Grand Island, NE
National Provider Identifier
1356014385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1057
- Practice address
- 2201 N Broadwell Ave
Grand Island, NE 68803-2153 - Phone
- (308) 389-5134
- NPI assigned
- Jul 27, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1057 | NE | Primary |
Addresses
Primary practice location
2201 N Broadwell Ave
Grand Island, NE 68803-2153
Mailing address
2201 N Broadwell Ave
Grand Island, NE 68803-2153
Phone (308) 389-5134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1057 | NE | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658966400000",
"number": "1356014385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 N BROADWELL AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688032153",
"telephone_number": "308-389-5134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 N BROADWELL AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688032153",
"telephone_number": "308-389-5134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEVLIN",
"first_name": "JENNIFER",
"middle_name": "NORIE MONIZ",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-27",
"last_updated": "2022-07-28",
"certification_date": "2022-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NE",
"license": "1057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Island, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.