Active NPI
Shannon Kiess, M.ED., BCBA
- Behavior Analyst
- St Lucie West, FL
National Provider Identifier
1104333434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-16-23919
- Practice address
- 2074 SE Doverbrook St
St Lucie West, FL 34983-4698 - Phone
- (772) 530-0575
- NPI assigned
- Jan 9, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-16-23919 | FL | Primary |
Addresses
Primary practice location
2074 SE Doverbrook St
St Lucie West, FL 34983-4698
Mailing address
2074 SE Doverbrook St
Port Saint Lucie, FL 34983-4698
Phone (772) 530-0575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| ABA Family Services | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Port Saint Lucie, FL
- NPI 1003314402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515456000000",
"number": "1104333434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2074 SE DOVERBROOK ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349834698",
"telephone_number": "772-530-0575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2074 SE DOVERBROOK ST",
"city": "ST LUCIE WEST",
"state": "FL",
"postal_code": "349834698",
"telephone_number": "772-530-0575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIESS",
"first_name": "SHANNON",
"credential": "M.ED., BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-09",
"last_updated": "2018-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "1-16-23919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Lucie West, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.