Provider Demographics
NPI:1235661885
Name:RUMPH, JODI KIM (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:KIM
Last Name:RUMPH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:KIM
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1916 CONN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7814
Mailing Address - Country:US
Mailing Address - Phone:512-810-2301
Mailing Address - Fax:
Practice Address - Street 1:1916 CONN CREEK RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7814
Practice Address - Country:US
Practice Address - Phone:512-810-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-24106103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst