JACKIE NICOLE ELLIS (NPI# 1669090817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669090817 |
| Entity Type | Individual |
| Full Name | JACKIE NICOLE ELLIS |
| Practice Address |
14 Garden Ctr Broomfield CO 80020-7314 |
| Mailing Address |
1055 E Colorado Blvd Ste 560 Pasadena CA 91106-2380 |
| Practice Telephone | 8552953276 |
| Mailing Telephone | 8182416780 |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| Street Address |
14 GARDEN CTR |
| City | BROOMFIELD |
| State | CO |
| Zip Code | 80020-7314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316004732 | Dorothy C A Reinagel | Counselor | 14 Garden Ctr, Broomfield, CO 80020 | 2007-01-03 |
| 1033716766 | Chloe Weber | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-10-06 |
| 1033722582 | Haley Dust | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-08-25 |
| 1598377806 | Eleanor Stanish | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-08-18 |
| 1902439722 | Eric Andrade | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-02-20 |
| 1134759061 | Christopher Antillon | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-01-20 |
| 1124658307 | Julia Huldin | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-01-16 |
| 1336789163 | Amanda Kiesling | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-01-09 |
| 1861031262 | Kacy Moser | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-01-02 |
| 1659913085 | Anna Smith | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2019-10-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487210993 | Terri Lynn Rist | Day Training, Developmentally Disabled Services | 12161 Crabapple Street, Broomfield, CO 80020 | 2019-05-10 |
| 1063984409 | This Is Massage | Registered Nurse | 2625 W 133rd Circle Dr., Broomfield Co, CO 80020 | 2018-12-26 |
| 1588187678 | Jenny St. Claire | Counselor | 80 Garden Ctr Ste 140, Broomfield, CO 80020 | 2017-07-20 |
| 1649791880 | Brett T Nelson | Dentist | 340 East 1st Avenue, Suite 202, Broomfield, CO 80020 | 2017-06-28 |
| 1073033411 | Patrice S Lensmire Gauthier | Occupational Therapist | 12970 Sheridan Blvd, Broomfield, CO 80020 | 2017-06-27 |
| 1871047753 | Michelle L Fussnecker | Physician Assistant | 6450 W 120th Ave Unit A, Broomfield, CO 80020 | 2016-08-09 |
| 1588029565 | Courtney Miller | Marriage & Family Therapist | 26 Garden Center Suite 1, Broomfield, CO 80020 | 2015-12-17 |
| 1659742161 | Heather Scott | Physician Assistant | 340 E 1st Ave Ste 100, Broomfield, CO 80020 | 2015-10-09 |
| 1154701407 | Emily Arrington | Speech-Language Pathologist | 1790 W 6th Ave, Broomfield, CO 80020 | 2015-06-02 |
| 1376939884 | Retro Dental Group Broomfield | Dentist | 5105 120th Ave, Broomfield, CO 80020 | 2015-04-10 |
| Find all providers in zip 80020 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861027906 | Rachel Anne Oester | Behavior Technician | 7971 Uptown Ave Unit 11-110, Broomfield, CO 80021-4152 | 2020-03-09 |
| 1063078343 | Alexa Berg | Behavior Technician | 7971 Uptown Ave Unit 206, Broomfield, CO 80021-4152 | 2019-05-13 |
| 1043783327 | Ryan Everett Schacker | Behavior Technician | 120 Edgeview Dr Apt 6310, Broomfield, CO 80021-8098 | 2019-01-09 |
| 1144772484 | Jeff Godinez | Behavior Technician | 7402 Church Ranch Blvd Apt 433, Broomfield, CO 80021-5413 | 2016-11-03 |
| 1346847795 | Dana O'brien | Behavior Technician | 12286 Utica St, Broomfield, CO 80020-5640 | 2020-10-07 |
| 1225635725 | Kay Thresher | Behavior Technician | 12286 Utica St, Broomfield, CO 80020-5640 | 2020-10-07 |
| 1033716766 | Chloe Weber | Behavior Technician | 14 Garden Ctr, Broomfield, CO 80020-7314 | 2020-10-06 |
| 1548867401 | Kayla Lard | Behavior Technician | 12286 Utica St, Broomfield, CO 80020-5640 | 2020-10-05 |
| 1497352447 | Emily Kempf | Behavior Technician | 12286 Utica St, Broomfield, CO 80020-5640 | 2020-10-02 |
| 1588261689 | Blake Boseneiler | Behavior Technician | 12286 Utica St, Broomfield, CO 80020-5640 | 2020-10-02 |
| Find all providers in BROOMFIELD | ||||
| City | BROOMFIELD |
| Zip Code | 80020 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.