Jodie Lynn Deruyter, MS, BA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

45-140 Issued in WI

Practice address

1210 Fourier Dr
Suite #100
Madison, WI 53717-1969

Phone

(608) 662-9327

Fax

(608) 662-9041

NPI assigned

Sep 14, 2012

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

• Jodie Lynn Waldbauer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts, Master of Science

State licenses

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.

• Autism Spectrum Therapies of Delaware, LLC

  • Clinical Psychologist
  • Madison, WI
  • NPI 1043406978

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347580800000",
    "number": "1104176387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 FOURIER DRIVE",
            "address_2": "SUITE #100",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171969",
            "telephone_number": "608-662-9327",
            "fax_number": "608-662-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 FOURIER DR",
            "address_2": "SUITE #100",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171969",
            "telephone_number": "608-662-9327",
            "fax_number": "608-662-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUYTER",
        "first_name": "JODIE",
        "middle_name": "LYNN",
        "credential": "MS, BA, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-14",
        "last_updated": "2012-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "45-140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODIE",
            "last_name": "WALDBAUER",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• R. Lawrence Deroo, MS
• Rachel Marie Deroos, M.S.
• Ryan Michael Derose, DPT
• Penny K Derringer, PA-C
• Ashley Derry
• Hem Hemantbhai Desai, M.D.
• Niketa Desai, M.D.
• Yash Desai, MD
• Kenneth B Desantes, MD
• Ryan L Desanti, DO

• All providers in Madison, WI
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; 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.