Provider Demographics
NPI:1326504002
Name:MEDURI, JEREMY DANIEL (BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DANIEL
Last Name:MEDURI
Suffix:
Gender:M
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1502
Mailing Address - Country:US
Mailing Address - Phone:330-283-4145
Mailing Address - Fax:440-296-8514
Practice Address - Street 1:896 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1502
Practice Address - Country:US
Practice Address - Phone:330-283-4145
Practice Address - Fax:440-296-8514
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-17-28658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst