Provider Demographics
NPI:1891421137
Name:POTTER, NANCY J (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:POTTER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-1409
Mailing Address - Country:US
Mailing Address - Phone:970-352-6807
Mailing Address - Fax:
Practice Address - Street 1:5131 S COLLEGE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3968
Practice Address - Country:US
Practice Address - Phone:970-324-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst