Individual
JACK BUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5923 RIDGEBURY BLVD, CLEVELAND, OH 44124-1638
(440) 637-3599
Mailing address
DEPT 781625 PO BOX 78000, DETROIT, MI 48278-1625
(614) 355-8004
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB471643
OH
106S00000X
Behavior Technician
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
11/05/2018
Last updated
07/22/2025
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