Matthew R Dejesus
Behavior Analyst in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1689205387
StatusActive
Last updated in NPPESAug 6, 2026
Details
- NPI
- 1689205387
- Entity type
- Individual (NPI-1)
- Name
- Matthew R Dejesus
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 31, 2020
- Certification date
- Aug 6, 2026
- Last updated
- Aug 6, 2026
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 |
|---|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-24-76981 | IN | Yes |
| 106S00000X | Behavior Technician | RBT-19-106957 | IN |
Practice location
6131 N Clinton StFort Wayne, IN 46825-4905
Phone 260-459-6040
Mailing address
201 E Rudisill BlvdFort Wayne, IN 46806-1738
Phone 260-255-3665
Other practice locations
4422 E State Blvd
Fort Wayne, IN 46815-6917
Fort Wayne, IN 46815-6917
Phone 260-471-9263 · Fax 317-520-8200
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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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