NPIMap

Organization Active NPI

Easter Seals - Ucp

  • Behavior Analyst
  • Peoria, IL
National Provider Identifier
1083983738
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
EASTER SEALS - UCP
Practice address
507 E Armstrong Ave
Peoria, IL 61603-3201
Phone
(309) 686-1177
Fax
(309) 686-7722
NPI assigned
Dec 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Riddle, CPA, CGMA
Title
President
Phone
(309) 686-1177

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X

Addresses

Primary practice location

507 E Armstrong Ave
Peoria, IL 61603-3201

Mailing address

507 E Armstrong Ave
Peoria, IL 61603-3201
Phone (309) 686-1177

Other practice location 1

202 Saint Joseph Dr
Bloomington, IL 61701-3638
Phone (309) 686-1177

National Provider Directory

National Provider Directory
Tax ID family
Easter Seals - Ucp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

202 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 663-8275

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1083983738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-686-1177",
            "fax_number": "309-686-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-686-1177",
            "fax_number": "309-686-7722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "202 Saint Joseph Dr",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IL",
            "postal_code": "617013638",
            "country_code": "US",
            "telephone_number": "309-686-1177",
            "fax_number": "309-686-7722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTER SEALS - UCP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "RIDDLE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-686-1177",
        "authorized_official_credential": "CPA, CGMA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.