Provider Demographics
NPI:1831603513
Name:PRATT, MADISON (RBT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PRATT
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 1:1600 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1568
Mailing Address - Country:US
Mailing Address - Phone:402-318-3105
Mailing Address - Fax:402-318-3677
Practice Address - Street 1:1600 S 70TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1568
Practice Address - Country:US
Practice Address - Phone:402-318-3105
Practice Address - Fax:402-318-3677
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-17-44117103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid