MEDICARE: JADA RENEE MCLEOD STATEN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-88488	GA

General Provider Information

NPI Number	:	1427566744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA RENEE MCLEOD STATEN BCBA

Provider Business Mailing Address
First Line	:	410 MALL BLVD STE G
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-4869
Country	:	US
Telephone Number	:	404-446-9194
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 MALL BLVD STE G
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-4869
Country	:	US
Telephone Number	:	404-446-9194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	04/01/2026

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