Provider Demographics
NPI:1427709344
Name:NELSEN, CHANTELLE RAE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:RAE
Last Name:NELSEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1201
Mailing Address - Country:US
Mailing Address - Phone:402-375-3005
Mailing Address - Fax:402-375-1205
Practice Address - Street 1:901 E 14TH ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1201
Practice Address - Country:US
Practice Address - Phone:402-375-3005
Practice Address - Fax:402-375-1205
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEBACB334794103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst