Provider Demographics
NPI:1265970453
Name:WERDERITCH, JOSEPH JOHN (BCBA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:WERDERITCH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-7605
Mailing Address - Country:US
Mailing Address - Phone:224-583-2400
Mailing Address - Fax:
Practice Address - Street 1:9021 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-2040
Practice Address - Country:US
Practice Address - Phone:708-354-4547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician