Healthcare Provider Details

I. General information

NPI: 1073392494
Provider Name (Legal Business Name): JORDYN IVES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S COLTRANE RD STE A
EDMOND OK
73034-6729
US

IV. Provider business mailing address

2021 E ROCK CREEK RD
TUTTLE OK
73089-8757
US

V. Phone/Fax

Practice location:
  • Phone: 405-434-3052
  • Fax:
Mailing address:
  • Phone: 405-434-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2845391
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: