Joudly Peterson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-22-241855 Issued in SD

Practice address

2475 W Chicago St
Rapid City, SD 57702-2467

Phone

(605) 206-5004

NPI assigned

Nov 8, 2022

Last updated

Nov 8, 2022By the provider in NPPES

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Black Hills Behavior, LLC

  dba Impact Learning & Development

  • Behavior Analyst
  • Rapid City, SD
  • NPI 1619442522

  Behavior Technician

  NPD (past)

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1649988783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 W CHICAGO ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 W CHICAGO ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022467",
            "telephone_number": "605-206-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOUDLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "SD",
            "license": "RBT-22-241855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Peterson
• Calista Peterson
• Casey H Peterson, MS
• Cassidy Peterson, PA-C
• Jolene Peterson, MSW LCSW PIP
• Megan Peterson
• Natalie Peterson, CNP
• Randee Peterson
• Scott Peterson, PHARM. D.
• Wendy Peterson, PA

• Behavior Technician in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Behavior Technician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.