=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952227878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAILYN REIS SULLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2026
-----------------------------------------------------
Last Update Date | 06/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14611 W CENTER RD
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144-3219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-275-4124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 W 10TH ST
-----------------------------------------------------
City | SCHUYLER
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68661-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-370-0424
-----------------------------------------------------
Fax | 402-370-0424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------