Healthcare Provider Details

I. General information

NPI: 1063226496
Provider Name (Legal Business Name): JADE HEUER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 S EASTERN AVE STE 200
LAS VEGAS NV
89123-2545
US

IV. Provider business mailing address

8275 S EASTERN AVE STE 200
LAS VEGAS NV
89123-2545
US

V. Phone/Fax

Practice location:
  • Phone: 702-302-4435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-335213
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: