Provider Demographics
NPI:1134739279
Name:NELSON, JAYMI (BCBA)
Entity type:Individual
Prefix:
First Name:JAYMI
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 GREENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4452
Mailing Address - Country:US
Mailing Address - Phone:612-509-6690
Mailing Address - Fax:
Practice Address - Street 1:1308 GREENWOOD CT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4452
Practice Address - Country:US
Practice Address - Phone:161-235-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1-24-71109103K00000X
MNRBT-20-146620106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician