Jordan Kevin Woodruff

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-15-2763-06274 Issued in UT

Practice address

11715 S State St Apt E204
Draper, UT 84020-6910

Phone

(208) 965-4563

NPI assigned

Apr 8, 2019

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

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554681600000",
    "number": "1447713557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11715 S STATE ST APT E204",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11715 S STATE ST APT E204",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206910",
            "telephone_number": "208-965-4563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODRUFF",
        "first_name": "JORDAN",
        "middle_name": "KEVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2019-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": "UT",
            "license": "RBT-15-2763-06274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Womack
• Adrianna Wong
• Samantha Wong, DPT, PT
• Tyler Thomas Wood, DO
• Spencer C Woodbury, D.D.S.
• Erin Woods
• Garrison Woods
• Rachel Jordan Woods, M.D.
• Lindsey Woodward
• Glade Woolstenhulme

• Behavior Technician in Draper, UT
• Providers in Draper, UT by specialty
• Behavior Technician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; 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.