MEDICARE: JORDAN DAWON SIMONTON-BROWNE RBT

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	106S00000X	Behavior Technician	RBT-23-	NV

General Provider Information

NPI Number	:	1972285815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN DAWON SIMONTON-BROWNE RBT

Provider Business Mailing Address
First Line	:	1060 WIGWAM PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8162
Country	:	US
Telephone Number	:	702-547-6971
Fax Number	:	702-547-6948

Provider Business Practice Location Address
First Line	:	5765 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2536
Country	:	US
Telephone Number	:	702-547-6971
Fax Number	:	702-547-6948

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

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “ JORDAN DAWON SIMONTON-BROWNE RBT” Practice Location

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