Individual
JACOB ANDREW DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA, RBT
Contact information
Practice address
2904 FOLTZ DR, EDGEWOOD, KY 41017-2525
(859) 795-3000
(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
RBT-19-98801
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-19-98801
RBT CERTIFICATE
KY
Enumeration date
09/24/2019
Last updated
09/24/2019
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