Jason Mizak, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-23-280471 Issued in OR

Practice address

3715 NE Highway 20
Corvallis, OR 97330-9209

Phone

(303) 880-3745

Fax

(813) 441-8362

NPI assigned

Sep 8, 2023

Sex

Male

Sole proprietor

Yes

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

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.

• Sr Plus Behavior Consultants of Pacific Northwest

  • Behavior Analyst
  • Corvallis, OR
  • NPI 1073276945

  Behavior Technician

  NPD

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1245017771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 NE HIGHWAY 20",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973309209",
            "telephone_number": "303-880-3745",
            "fax_number": "813-441-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 NE HIGHWAY 20",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973309209",
            "telephone_number": "303-880-3745",
            "fax_number": "813-441-8362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZAK",
        "first_name": "JASON",
        "credential": "RBT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "OR",
            "license": "RBT-23-280471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abraham James Mitchell, BS
• Ashley Janette Mitchell
• Christopher Leon Mitchell Jr.
• Erin Elizabeth Mitchell, LPC
• Jessica Mitchell, M.D.
• Vanessa Kelly Mizak, FNP-C, AGCNS-BC
• Latu Silatolu Moala
• Sunni M. Modaffari, LPC
• Kathryn L Moen, P.T
• Kristin Elizabeth Moen, RN, DNP, PMHNP-BC

• Behavior Technician in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Behavior Technician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.