Provider Demographics
NPI:1659881472
Name:CASETTA, JORDYNN
Entity Type:Individual
Prefix:
First Name:JORDYNN
Middle Name:
Last Name:CASETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3396
Mailing Address - Country:US
Mailing Address - Phone:480-799-5079
Mailing Address - Fax:866-833-2056
Practice Address - Street 1:4500 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3396
Practice Address - Country:US
Practice Address - Phone:480-799-5079
Practice Address - Fax:866-833-2056
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-17-40812106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician