Jordyn M Johnson, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

4559 Benes Ave
Glen Carbon, IL 62034

Phone

(217) 525-8332

Fax

(217) 789-1420

NPI assigned

Jun 25, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jordyn M Roady Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hope Clinical Care

  • Home Health Agency
  • Saint Louis, MO
  • NPI 1467590125

  Behavior Analyst

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1063907855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 6TH STREET FRONTAGE RD E STE 1700",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627035771",
            "telephone_number": "217-525-8332",
            "fax_number": "217-789-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4559 BENES AVE",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "62034",
            "telephone_number": "217-525-8332",
            "fax_number": "217-789-1420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 N Park Ave",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483046",
            "country_code": "US",
            "telephone_number": "217-525-8332",
            "fax_number": "217-789-1420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3022 S Park Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483721",
            "country_code": "US",
            "telephone_number": "217-525-8332",
            "fax_number": "217-789-1420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "145 Springfield Ct",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622692495",
            "country_code": "US",
            "telephone_number": "217-525-8332",
            "fax_number": "217-789-1420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5220 6th Street Frontage Rd E Ste 1700",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627035771",
            "country_code": "US",
            "telephone_number": "217-525-8332",
            "fax_number": "217-789-1420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Rottingham Ct Ste A",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620253677",
            "country_code": "US",
            "telephone_number": "866-522-2467",
            "fax_number": "217-789-1420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JORDYN",
        "middle_name": "M",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDYN",
            "last_name": "ROADY",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristen James, M.D.
• Jessica M Jarman
• Jeffrey S. Mastroianni D.M.D., M.S., P.C.
• Jeffrey S. Mastroianni, D.M.D., M.S.
• Elisa Renee Jellen, L.PC
• Reginald Deon Johnson
• Cherish Irielle Jones, RBT
• Joshua C Allison
• Kaitlyn Juilfs, NP
• Kaleidoscope Therapy, LLC

• Behavior Analyst in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.