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NPI Code Detail

MEDICARE: JORDIN GOOD RBT

MEDICARE: JORDIN GOOD RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1417510413
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDIN GOOD RBT
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 6925 PARKDALE PL
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-4673
Country : US
Telephone Number : 317-597-4553
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2019
Last Update Date : 04/16/2019

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