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General NPI Number Information
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NPI Number | 1427709344
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Entity Type | Individual
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Provider Name | CHANTELLE RAE NELSEN BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 901 E 14TH ST
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City | WAYNE
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State | NE
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Zip | 68787-1201
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Country | US
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Telephone | 402-375-3005
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Fax | 402-375-1205
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Provider Business Mailing Address
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Address Line | 901 E 14TH ST
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City | WAYNE
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State | NE
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Zip | 68787-1201
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Country | US
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Telephone | 402-375-3005
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Fax | 402-375-1205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB334794
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License Number State | NE
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