Healthcare Provider Details

I. General information

NPI: 1104300318
Provider Name (Legal Business Name): ZOEY MARGARET BACK MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 S 138TH ST
OMAHA NE
68144-3318
US

IV. Provider business mailing address

3424 S 138TH ST
OMAHA NE
68144-3318
US

V. Phone/Fax

Practice location:
  • Phone: 442-320-4949
  • Fax: 402-751-9080
Mailing address:
  • Phone: 442-320-4949
  • Fax: 402-751-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2117
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: