JACOB ANDREW DIETZ (NPI# 1659922441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659922441 |
| Entity Type | Individual |
| Full Name | JACOB ANDREW DIETZ |
| Credential | BA, RBT |
| Practice Address |
2904 Foltz Dr Edgewood KY 41017-2525 |
| Mailing Address |
3500 Depauw Blvd Ste 3070 Indianapolis IN 46268-6135 |
| Practice Telephone | 8597953000 |
| Practice Fax Number | 3175208200 |
| Mailing Telephone | 8553240885 |
| Mailing Fax Number | 3175208200 |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103K00000X | Behavioral Analyst | RBT-19-98801 | KY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | RBT CERTIFICATE | RBT-19-98801 | 01 |
| Street Address |
2904 FOLTZ DR |
| City | EDGEWOOD |
| State | KY |
| Zip Code | 41017-2525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134427628 | Katelyn Rose Mullen | Behavioral Analyst | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2011-03-07 |
| 1063029445 | Sydney Renee Ely | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-09-29 |
| 1548877103 | Bailey Nicole Dorsey | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-09-28 |
| 1881200939 | Callie Nicole Bolling | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-09-23 |
| 1053927103 | Allason Paige Toler | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-09-23 |
| 1588279186 | Megan Nicole Bosma | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-09-10 |
| 1255943981 | Morgan Christian Calhoun | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-08-24 |
| 1275143836 | Leah Brianna Dale | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-08-07 |
| 1235749896 | Griffin Neal Stanley | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-08-07 |
| 1174149330 | Courtney Lynn Gerbus | Behavior Technician | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2020-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578187209 | St. Elizabeth Medical Center, Inc. | Pharmacy | 1 Medical Village Dr., Edgewood, KY 41017 | 2020-05-28 |
| 1366084337 | St. Elizabeth Medical Center, Inc. | Pharmacy | 850 Thomas More Parkway, Edgewood, KY 41017 | 2019-10-11 |
| 1396396750 | Family First Vision Care Kentucky | Optometrist | 614 Buttermilk Pike, Fort Mitchell, KY 41017 | 2019-09-26 |
| 1083184543 | Katie Franconia Smith | Nurse Practitioner | 2865 Chancellor Dr., Crestview Hills, KY 41017 | 2018-11-27 |
| 1871077511 | Janet Reeves Martin | Nurse Practitioner | Infinity Dialysis, 4750 East Galbraith Rd. Suite 103, Cincinnati, OH 41017 | 2018-09-19 |
| 1144713983 | Kelly Wiechart | Dentist | 599 Freedom Park Dr Ste 100, Crestview Hills, KY 41017 | 2018-06-06 |
| 1225535966 | Proscan Radiology Northern Kentucky, LLC | Radiology | 350 Thomas More Pkwy Ste 170, Crestview Hills, KY 41017 | 2018-04-10 |
| 1396241626 | Tressa S. Leahy | Physical Therapist | 200 Medical Village Drive, Edgewood, KY 41017 | 2018-04-04 |
| 1699294470 | Raymond Gardinier | Physical Therapist | 3755 Old Ky 17, Fort Wright, KY 41017 | 2017-09-13 |
| 1992229785 | Adrienne Bussard | Physician Assistant | 334 Thomas More Pkwy Ste 120, Crestview Hills, KY 41017 | 2017-08-02 |
| Find all providers in zip 41017 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912403429 | Kyle Elizabeth Gundling-childs | Behavioral Analyst | 31 Bella Vista Rd, Edgewood, NM 87015-7097 | 2018-04-03 |
| 1952840860 | Bluegrass Behavioral Health Group | Behavioral Analyst | 925 Dudley Pike, Edgewood, KY 41017-8120 | 2017-02-13 |
| 1679932909 | Shannon Dennison | Behavioral Analyst | 179 Thunder Mountain Rd, Edgewood, NM 87015-8750 | 2016-02-15 |
| 1104165190 | Christina Marie Hentz | Behavioral Analyst | 10 Vista Encantada, Edgewood, NM 87015-9530 | 2013-02-11 |
| 1134427628 | Katelyn Rose Mullen | Behavioral Analyst | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2011-03-07 |
| 1154946929 | Stephanie Walker | Behavioral Analyst | 925 Dudley Pike, Edgewood, KY 41017-8120 | 2020-06-08 |
| 1376181651 | Leah Kathleen Snyder | Behavioral Analyst | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2019-12-17 |
| 1033760210 | Nicole Testory | Behavioral Analyst | 925 Dudley Pike, Edgewood, KY 41017-8120 | 2019-09-27 |
| 1043861826 | Kathleen Louise Weiland | Behavioral Analyst | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2019-09-24 |
| 1609427491 | Sydney Marie Reinert | Behavioral Analyst | 2904 Foltz Dr, Edgewood, KY 41017-2525 | 2019-09-24 |
| Find all providers in EDGEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.