Healthcare Provider Details

I. General information

NPI: 1366374472
Provider Name (Legal Business Name): JAYDA WATERS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 HILLEGAS RD
FORT WAYNE IN
46808-3859
US

IV. Provider business mailing address

9037 STELLHORN CROSSING PKWY
FORT WAYNE IN
46815-5860
US

V. Phone/Fax

Practice location:
  • Phone: 260-338-1241
  • Fax: 260-338-1241
Mailing address:
  • Phone: 260-338-1241
  • Fax: 260-338-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: