Jacob D Glissmeyer

Key facts

NPI

1689172728

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Analyst 103K00000X

Practice address

3006 S Highland Dr Ste 210
Salt Lake City, UT 84106-3020

Phone

(801) 679-5352

NPI assigned

Jan 23, 2018

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• Apex Behavior Consulting LLC Behavior Analyst · Salt Lake City, UT · NPI 1528369980
  NPD (past) BEHAVIOR ANALYST

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 23, 2018.

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516665600000",
    "number": "1689172728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3006 S HIGHLAND DR STE 210",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841063020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3006 S HIGHLAND DR STE 210",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841063020",
            "telephone_number": "801-679-5352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLISSMEYER",
        "first_name": "JACOB",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Salt Lake City, UT · Behavior Analyst in Utah