Provider Demographics
NPI:1477310225
Name:COOK, JADACIE
Entity Type:Individual
Prefix:
First Name:JADACIE
Middle Name:
Last Name:COOK
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 1:2440 VASSAR ST STE 1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3224
Mailing Address - Country:US
Mailing Address - Phone:775-448-6533
Mailing Address - Fax:
Practice Address - Street 1:2440 VASSAR ST STE 1
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3224
Practice Address - Country:US
Practice Address - Phone:775-448-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4109106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT4109OtherSTATE OF NEVADA BOARD OF APPLIED BEHAVIOR ANALYSIS
NVRBT-24-329437OtherBEHAVIOR ANALYST CERTIFICATION BOARD