Healthcare Provider Details

I. General information

NPI: 1619829108
Provider Name (Legal Business Name): JACQUELYN LEET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 FNB PKWY STE 100
OMAHA NE
68154-7200
US

IV. Provider business mailing address

5636 S 48TH AVE
OMAHA NE
68117-2516
US

V. Phone/Fax

Practice location:
  • Phone: 402-807-7447
  • Fax:
Mailing address:
  • Phone: 402-321-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: