Jarel Gordon, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

0133000357 Issued in VA

Practice address

1028 Winona Ave SW
Roanoke, VA 24015-5328

Phone

(540) 815-1693

NPI assigned

Oct 27, 2014

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wild Child Therapeutic Services

  • Behavior Analyst
  • Roanoke, VA
  • NPI 1235763384
  NPD (past) Authorized official

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1518362003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 WINONA AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240155328",
            "telephone_number": "540-815-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 WINONA AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240155328",
            "telephone_number": "540-815-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JAREL",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-27",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0133000357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corey Goodwin, PHARMD
• Megan Goodwin, PHARMD
• Justin Reece Goolcharan, M.D.
• Douglas James Gordon, DO
• Jared Junior Jacob Gordon, MD
• Jed Gorman, DPT
• Kevin Hans Goslen, MD
• Caitlin Dianna Gove, FNP-BC
• Nicole Graboski
• Jamie M Grace

• Behavior Analyst in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; 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.