Active NPI
Jacob Timothy Spitzack
- Behavior Analyst
- Eugene, OR
National Provider Identifier
1508334491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 10195019
- Practice address
- 360 S Garden Way Ste 250
Eugene, OR 97401-8175 - Phone
- (541) 726-1465
- NPI assigned
- Nov 8, 2018
- 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 | 10195019 | OR | Primary |
Addresses
Primary practice location
360 S Garden Way Ste 250
Eugene, OR 97401-8175
Mailing address
460 E 14TH Ave Apt 11
Eugene, OR 97401-8223
Phone (651) 403-2514
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 |
|---|---|---|---|
| 10195019 | OR | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541635200000",
"number": "1508334491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 E 14TH AVE APT 11",
"city": "EUGENE",
"state": "OR",
"postal_code": "974018223",
"telephone_number": "651-403-2514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 S GARDEN WAY STE 250",
"city": "EUGENE",
"state": "OR",
"postal_code": "974018175",
"telephone_number": "541-726-1465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPITZACK",
"first_name": "JACOB",
"middle_name": "TIMOTHY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-08",
"last_updated": "2018-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "10195019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.