MEDICARE: JACLYN DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14596	NE
2	106E00000X	Assistant Behavior Analyst
3	106S00000X	Behavior Technician
4	106E00000X	Assistant Behavior Analyst	0-19-9659	NE

General Provider Information

NPI Number	:	1386150845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN DAVIS

Provider Business Mailing Address
First Line	:	13322 I ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1111
Country	:	US
Telephone Number	:	402-230-5861
Fax Number	:	531-200-5808

Provider Business Practice Location Address
First Line	:	11819 MIRACLE HILLS DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-5308
Country	:	US
Telephone Number	:	402-414-4131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	08/27/2025

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