Jennifer Sue Dodge, BACB499833

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-21-178990 Issued in WA

Practice address

42 Lost River Rd
Mazama, WA 98833-9707

Phone

(404) 247-4514

NPI assigned

Jun 28, 2021

Last updated

Aug 23, 2021By 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 2

Addresses

Electronic endpoints 1

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": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1659941086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 154",
            "city": "BREWSTER",
            "state": "WA",
            "postal_code": "988120154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 LOST RIVER RD",
            "city": "MAZAMA",
            "state": "WA",
            "postal_code": "988339707",
            "telephone_number": "404-247-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "JENNIFER",
        "middle_name": "SUE",
        "credential": "BACB499833",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WA",
            "license": "BACB499833",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WA",
            "license": "RBT-21-178990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pkservice.org",
            "affiliation": "Y",
            "affiliationName": "Peak Behavioral Health, LLC",
            "address_1": "42 Lost River Rd",
            "city": "Mazama",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988339707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elaine Marquez, LMP-C
• Michael John Pritchard, L.M.P.

• Behavior Technician in Mazama, WA
• Providers in Mazama, WA by specialty
• Behavior Technician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; 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.