Provider Demographics
NPI:1922783489
Name:DADE, JAQUELA (RBT)
Entity Type:Individual
Prefix:
First Name:JAQUELA
Middle Name:
Last Name:DADE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-2671
Mailing Address - Country:US
Mailing Address - Phone:412-712-5693
Mailing Address - Fax:
Practice Address - Street 1:900 TUTOR LN STE 107
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7295
Practice Address - Country:US
Practice Address - Phone:812-602-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-23-279684106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician