Jennifer Brossman, RBT-23-253709

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-23-253709 Issued in OK

Practice address

1222 W Westchester Way
Mustang, OK 73064-2303

Phone

(405) 816-1014

Fax

(405) 422-8249

NPI assigned

Oct 11, 2011

Last updated

Jan 23, 2023By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1174808034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 POINTE PARKWAY BLVD",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730990600",
            "telephone_number": "405-805-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 W WESTCHESTER WAY",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730642303",
            "telephone_number": "405-816-1014",
            "fax_number": "405-422-8249"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Pointe Parkway Blvd",
            "address_purpose": "LOCATION",
            "city": "Yukon",
            "state": "OK",
            "postal_code": "730990600",
            "country_code": "US",
            "telephone_number": "405-805-6403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROSSMAN",
        "first_name": "JENNIFER",
        "credential": "RBT-23-253709",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-11",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "OK",
            "license": "RBT-23-253709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RBT-23-253709",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Mustang, OK
• Providers in Mustang, OK by specialty
• Behavior Technician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.