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General NPI Number Information
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NPI Number | 1265970453
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Entity Type | Individual
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Provider Name | JOSEPH JOHN WERDERITCH BCBA
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 9021 OGDEN AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-2040
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Country | US
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Telephone | 708-354-4547
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 E NORTHWEST HWY
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City | PALATINE
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State | IL
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Zip | 60074-7605
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Country | US
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Telephone | 224-583-2400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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