MEDICARE: JODI RYAN TEDESCO RBT

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	106S00000X	Behavior Technician	23-261941	TX

General Provider Information

NPI Number	:	1760222830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI RYAN TEDESCO RBT

Provider Business Mailing Address
First Line	:	7100 E PLEASANT VLY # 107
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-5544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3644 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3934
Country	:	US
Telephone Number	:	216-251-6841
Fax Number	:

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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Directions to “ JODI RYAN TEDESCO RBT” Practice Location

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