Jacob Dierlam

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

880 Roosevelt Rd
Glen Ellyn, IL 60137-7840

Phone

(815) 469-1500

Fax

(630) 686-1535

NPI assigned

Jan 20, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1205426533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601377840",
            "telephone_number": "805-469-1500",
            "fax_number": "630-686-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601377840",
            "telephone_number": "815-469-1500",
            "fax_number": "630-686-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERLAM",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Destefani, MD
• Alexis J Dettmer
• Diabetes and Endocrinology Care
• Dialyze Direct Il LLC
• Emily Dierking, LAT, ATC
• Raymond Dieter Jr., MD
• Victor H Dietz, M.A.P.C., J.D.
• Paul Edward Difranco, DDS, MS
• Diana Dimeo, LPC
• Gerard Dobkowski, MA LPC CPT

• Behavior Technician in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Behavior Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.