Jessica Ruddock

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1905 S Topaz Way Ste 100
Meridian, ID 83642-4477

Phone

(208) 518-0870

NPI assigned

Aug 16, 2024

Sex

Female

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

• Jessica Romine Former name

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": "1723766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1316779481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S BENEWAH DR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836512427",
            "telephone_number": "986-910-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 S TOPAZ WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424477",
            "telephone_number": "208-518-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDOCK",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-16",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "ROMINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Jo Royal, MS, CCC-SLP
• Shannon Roybal, M.S CCC-SLP
• Roytman DDS, P.C.
• RS Physical Therapy PC
• Agata Monika Rubis
• Makenna Dusty Rudolph
• Samantha J Ruggles, FNP
• Ellen Ruiz
• Jamie Lynn Ruiz, P.A.-C
• Kjeranne Rummel, APRN-CNP

• Behavior Technician in Meridian, ID
• Providers in Meridian, ID by specialty
• Behavior Technician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.

Verify at the official NPI Registry.