Active NPI
Geraldine Archana Jeyanthan
- Behavior Technician
- Vancouver, WA
National Provider Identifier
1265040299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- CB60917483
- Practice address
- 6409 E Mill Plain Blvd
Vancouver, WA 98661-7454 - Phone
- (360) 718-8376
- NPI assigned
- Jul 15, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CB60917483 | WA | Primary |
Addresses
Primary practice location
6409 E Mill Plain Blvd
Vancouver, WA 98661-7454
Mailing address
6409 E Mill Plain Blvd
Vancouver, WA 98661-7454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CB60917483 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716940800000",
"number": "1265040299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6409 E MILL PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986617454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6409 E MILL PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986617454",
"telephone_number": "360-718-8376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEYANTHAN",
"first_name": "GERALDINE",
"middle_name": "ARCHANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-15",
"last_updated": "2024-05-29",
"certification_date": "2024-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "CB60917483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.