Provider Demographics
NPI:1770324790
Name:BECKWITH, JADEALYN (RBT)
Entity type:Individual
Prefix:
First Name:JADEALYN
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:X
Credentials:RBT
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:BECKWITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:310 REGENCY PKWY #115
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:515-207-5251
Mailing Address - Fax:
Practice Address - Street 1:310 REGENCY PKWY #115
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:515-207-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-24-362084106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician