Jake Camron Edwards, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1141598 Issued in VT

Practice address

37 Talcott Rd
Suite 114
Williston, VT 05495-2094

Phone

(802) 662-7831

Fax

(802) 662-7834

NPI assigned

Apr 25, 2014

Last updated

Oct 7, 2016By the provider in NPPES

Sex

Male

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

• Carol M Edwards-Rich Former name

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• SD Associates, LLC

  • Behavior Analyst
  • Williston, VT
  • NPI 1275855975
  NPD (past)

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1184044323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 JERICHO RD",
            "address_2": "UNIT B",
            "city": "RICHMOND",
            "state": "VT",
            "postal_code": "054779173",
            "telephone_number": "802-734-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 TALCOTT RD",
            "address_2": "SUITE 114",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054952094",
            "telephone_number": "802-662-7831",
            "fax_number": "802-662-7834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JAKE",
        "middle_name": "CAMRON",
        "name_prefix": "Mr.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-25",
        "last_updated": "2016-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VT",
            "license": "1141598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "EDWARDS-RICH",
            "middle_name": "M",
            "credential": "BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan Dumais, BCBA
• Denise M Durant, M.D.
• Corey James Duteau, R.PH
• Charles Scott Earisman, MA
• Earth&Light, LLC (Lisa Marie Mallory Petersen)
• Eleanor Health Professional
• Joellen Emerson, BCABA
• Erin K. Hall, MD PLLC
• M Jacklynn Estes, RPH
• Laurie Euler, BCBA

• Behavior Analyst in Williston, VT
• Providers in Williston, VT by specialty
• Behavior Analyst in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; 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.