Active NPI
Jack Versten, RBT
- Behavior Technician
- Dekalb, IL
National Provider Identifier
1154800274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 18-56340
- Practice address
- 827 Charles St Apt C
Dekalb, IL 60115-1601 - Phone
- (847) 612-6581
- NPI assigned
- Aug 9, 2018
- Sex
- Male
- 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 Technician | 106S00000X | 18-56340 | IL | Primary |
Addresses
Primary practice location
827 Charles St Apt C
Dekalb, IL 60115-1601
Mailing address
827 Charles St Apt C
Dekalb, IL 60115-1601
Phone (847) 612-6581
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-56340 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533772800000",
"number": "1154800274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "827 CHARLES ST APT C",
"city": "DEKALB",
"state": "IL",
"postal_code": "601151601",
"telephone_number": "847-612-6581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "827 CHARLES ST APT C",
"city": "DEKALB",
"state": "IL",
"postal_code": "601151601",
"telephone_number": "847-612-6581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERSTEN",
"first_name": "JACK",
"credential": "RBT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-09",
"last_updated": "2018-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "18-56340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.