Provider Demographics
NPI:1841098431
Name:FRALICK, JORDYN LEIGH (RBT)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:LEIGH
Last Name:FRALICK
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:102 E NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMITVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46070-9322
Mailing Address - Country:US
Mailing Address - Phone:765-617-0681
Mailing Address - Fax:
Practice Address - Street 1:1030 N SR 37
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036
Practice Address - Country:US
Practice Address - Phone:765-617-2279
Practice Address - Fax:765-274-5244
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-365105106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician