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Individual

MATTHEW R DEJESUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
6131 N CLINTON ST, FORT WAYNE, IN 46825-4905
(260) 459-6040
Mailing address
201 E RUDISILL BLVD, FORT WAYNE, IN 46806-1738
(260) 255-3665

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-76981
IN
106S00000X
Behavior Technician
RBT-19-106957
IN

Other

Enumeration date
01/31/2020
Last updated
11/13/2024
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