Healthcare Provider Details

I. General information

NPI: 1003740531
Provider Name (Legal Business Name): JAYLA RUSHING RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53779 GENERATIONS DR STE C
SOUTH BEND IN
46635-1577
US

IV. Provider business mailing address

442 SAND CREEK DR
CHESTERTON IN
46304-1595
US

V. Phone/Fax

Practice location:
  • Phone: 219-359-3272
  • Fax: 219-359-3089
Mailing address:
  • Phone: 219-359-3272
  • Fax: 219-359-3089

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: