Healthcare Provider Details

I. General information

NPI: 1427566744
Provider Name (Legal Business Name): JADA RENEE MCLEOD STATEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MALL BLVD STE G
SAVANNAH GA
31406-4869
US

IV. Provider business mailing address

410 MALL BLVD STE G
SAVANNAH GA
31406-4869
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-9194
  • Fax:
Mailing address:
  • Phone: 404-446-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88488
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: