1912450446 NPI number — JORDYN PAIGE NIEDERHISER M.S., BCBA

Table of content: JORDYN PAIGE NIEDERHISER M.S., BCBA (NPI 1912450446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912450446 NPI number — JORDYN PAIGE NIEDERHISER M.S., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEDERHISER
Provider First Name:
JORDYN
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLIOTT
Provider Other First Name:
JORDYN
Provider Other Middle Name:
PAIGE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912450446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66206-0729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 DEERWOOD CAMPUS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32246-8317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-887-1797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-18-32840 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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