Jaeliah Lane

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

6 Eagle Ctr Ste 1
O Fallon, IL 62269-1945

Phone

(618) 206-8816

NPI assigned

Jan 6, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Acorn Health of Illinois, LLC

  • Behavior Analyst
  • O Fallon, IL
  • NPI 1144867854
  NPD

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1174111975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9902 W MAIN ST APT 10",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622231420",
            "telephone_number": "618-691-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EAGLE CTR STE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691945",
            "telephone_number": "618-206-8816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "JAELIAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-06",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "L500-4319-7616",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake Laird
• Jenelle Denise Lally-Roberts, RBT
• Deanna Lambert
• Kandace Lamonica, MD
• Portia Denise Lancaster
• Madison Christine Langley, RBT
• Megan N. Lanter
• Larose Counseling LLC
• Keely Deanna Lawler Sabaini, BCBA, M.S.
• Gregory G Lawson

• Behavior Technician in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Behavior Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.