Individual
JACOB ALEXANDER VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, BCBA, LBA
Contact information
Practice address
175 MARKET PLACE DR STE A, LOUISVILLE, KY 40229-4471
(502) 251-7002
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
278031
KY
106S00000X
Behavior Technician
RBT-19-102036
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-595-49
BCBA CERTIFICATE
—
01
—
RBT-19-102036
RBT CERTIFICATE
—
Enumeration date
12/20/2019
Last updated
06/08/2022
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