Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tate Ryley Jacobson

Individual provider Behavior Analyst · NPI 1679288344

Tate Ryley Jacobson is a Behavior Analyst in Fort Wayne, Indiana. Works from 2 locations. Licensed in Indiana.

Licensed in
IN
In the registry since
2023
Specialties on file
2

Practice location Address checks out

4422 E State Blvd
Fort Wayne, IN 46815-6917
Phone: (260) 471-9263
Fax: (317) 520-8200
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 201 E Rudisill Blvd Ste 100b, Fort Wayne, IN 46806-1756 — (260) 615-1450

Specialties & licences

Behavior Analyst (primary) Taxonomy 103K00000X · Licence 1-25-80017 (IN)
Behavior Technician Taxonomy 106S00000X

Record details

NPI number1679288344
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 17, 2023
Last updated in NPPESSeptember 8, 2025
Certification dateSeptember 8, 2025
Mailing address3500 Depauw Blvd Ste 3070, Indianapolis, IN 46268-6135

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