Healthcare Provider Details

I. General information

NPI: 1902361850
Provider Name (Legal Business Name): JADA LYNN GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 30042
RENO NV
89520-3042
US

IV. Provider business mailing address

PO BOX 30042
RENO NV
89520-3042
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45565
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0372
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: