Sydney Sophia Lauren Jacob
Behavior Technician in Bloomington, IN. Individual provider (NPI-1).
NPI number1619787199
StatusActive
Last updated in NPPESJan 8, 2025
Details
- NPI
- 1619787199
- Entity type
- Individual (NPI-1)
- Name
- Sydney Sophia Lauren Jacob
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 8, 2025
- Certification date
- Jan 8, 2025
- Last updated
- Jan 8, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
| 103K00000X | Behavior Analyst | – | – |
Practice location
239 E Winslow RdBloomington, IN 47401-8638
Phone 812-202-6001
Mailing address
2495 S Walnut Street PikeBloomington, IN 47401-8431
Phone 812-202-6001
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 699 Behavior Technician providers in Bloomington · All 4,023 providers in Bloomington
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