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General NPI Number Information
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NPI Number | 1710780044
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Entity Type | Individual
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Provider Name | JORDAN RUNGE BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 3625 UTICA RIDGE RD STE E
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City | BETTENDORF
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State | IA
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Zip | 52722-1653
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Country | US
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Telephone | 563-526-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 215 4TH AVE SE STE 300
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City | CEDAR RAPIDS
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State | IA
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Zip | 52401-1844
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Country | US
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Telephone | 563-542-9349
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-01191
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License Number State | IA
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