Provider Demographics
NPI:1457792566
Name:JOST, ANDREW JOHN (BCABA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:JOST
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W242N6416 LOCUST ST
Mailing Address - Street 2:APT 7
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3069
Mailing Address - Country:US
Mailing Address - Phone:262-501-3538
Mailing Address - Fax:
Practice Address - Street 1:W242N6416 LOCUST ST
Practice Address - Street 2:APT 7
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3069
Practice Address - Country:US
Practice Address - Phone:262-501-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0-13-5424103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst