Active NPI
Alyssa Raudebaugh-Jackson, BCBA
- Behavior Analyst
- Port St Lucie, FL
National Provider Identifier
1700426053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-22-62662
- Practice address
- 247 SW Port St. Lucie Blvd
Port St. Lucie, FL 34984 - NPI assigned
- Jan 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 1-22-62662 | FL | Primary |
Addresses
Primary practice location
247 SW Port St. Lucie Blvd
Port St. Lucie, FL 34984
Mailing address
300 International Parkway Suite 200
Lake Mary, FL 32746
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1700426053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 INTERNATIONAL PARKWAY SUITE 200",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "32746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "247 SW PORT ST. LUCIE BLVD",
"city": "PORT ST. LUCIE",
"state": "FL",
"postal_code": "34984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAUDEBAUGH-JACKSON",
"first_name": "ALYSSA",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-14",
"last_updated": "2022-12-08",
"certification_date": "2022-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "1-22-62662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 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.