Active NPI
Jeffrey Carl Tietjen
- Behavior Analyst
- Pullman, WA
National Provider Identifier
1295402477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 340 NE Maple St
Pullman, WA 99163-4120 - Phone
- (509) 334-1133
- NPI assigned
- Aug 25, 2021
- Sex
- Male
- 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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
340 NE Maple St
Pullman, WA 99163-4120
Mailing address
340 NE Maple St
Pullman, WA 99163-4120
Phone (509) 334-1133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7104177 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Pullman | Health Information Exchange (HIE) |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629849600000",
"number": "1295402477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 NE MAPLE ST",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991634120",
"telephone_number": "509-334-1133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 NE MAPLE ST",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991634120",
"telephone_number": "509-334-1133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIETJEN",
"first_name": "JEFFREY",
"middle_name": "CARL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-25",
"last_updated": "2021-08-25",
"certification_date": "2021-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7104177",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Pullman",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Pullman",
"address_1": "340 NE Maple St",
"city": "Pullman",
"state": "WA",
"country_code": "US",
"postal_code": "991634120",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pullman, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.