Holli Henningsen Jerdes

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BA60760954 Issued in WA

Practice address

905 Carlyon Ave SE
Olympia, WA 98501-3503

Phone

(360) 688-4321

NPI assigned

Feb 3, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Behaviorlytics: a Social Change Agency

  • Behavior Analyst
  • Olympia, WA
  • NPI 1194461798
  NPD Authorized official
• Behavior Analysts, Inc.

  • Behavior Analyst
  • Walnut Creek, CA
  • NPI 1457780504
  NPD (past)
• Behavior Analysts, Inc.

  • Community/Behavioral Health Agency
  • Walnut Creek, CA
  • NPI 1548595085
  NPD (past)

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

{
    "created_epoch": "1328227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1114299203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 CARLYON AVE SE STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985013503",
            "telephone_number": "360-688-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 CARLYON AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985013503",
            "telephone_number": "360-688-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "311 Lennon Ln",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945982418",
            "country_code": "US",
            "telephone_number": "925-210-9370",
            "fax_number": "925-210-0436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNINGSEN JERDES",
        "first_name": "HOLLI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-03",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1073813",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WA",
            "license": "BA60760954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Hendricks
• Grace Elisabeth Hendry
• Julie A Henegan, LCCE
• Richard Norman Henegan, MD
• Margaret Marie Hennessey, FNP
• Henricksen Physical Therapy PLLC
• Kelli Ann Henricksen, DPT
• Stephanie Henriet, MA
• Victoria Rose Henrikson, DNP, FNP-C
• Henry L Degive MD MC PS

• Behavior Analyst in Olympia, WA
• Providers in Olympia, WA by specialty
• Behavior Analyst in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.