Provider Demographics
NPI:1447097373
Name:HEITTER, JARREN (RBT)
Entity type:Individual
Prefix:
First Name:JARREN
Middle Name:
Last Name:HEITTER
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1319 N GALENA AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1009
Mailing Address - Country:US
Mailing Address - Phone:815-440-6134
Mailing Address - Fax:855-620-0303
Practice Address - Street 1:1319 N GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1009
Practice Address - Country:US
Practice Address - Phone:815-440-6134
Practice Address - Fax:855-620-0303
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-24-359922106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician