Provider Demographics
NPI:1336607712
Name:TAGEL, JODIE LEE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:LEE
Last Name:TAGEL
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 1:13605 S 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68059-3200
Mailing Address - Country:US
Mailing Address - Phone:402-672-9269
Mailing Address - Fax:
Practice Address - Street 1:3534 S 108TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4910
Practice Address - Country:US
Practice Address - Phone:402-281-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31602103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-31602OtherBEHAVIOR ANALYST CERTIFICATION BOARD