Active NPI
Justin Joseph Ingraham
- Behavior Technician
- Grand Rapids, MI
National Provider Identifier
1194286278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2814 Woodcliff Cir SE
Grand Rapids, MI 49506-3155 - Phone
- (248) 622-1595
- NPI assigned
- Mar 29, 2019
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
2814 Woodcliff Cir SE
Grand Rapids, MI 49506-3155
Mailing address
10897 48TH Ave Building Z, Apartment 6, Allendale, Mi,
Allendale, MI 49401
Phone (231) 590-8982
Other practice location 1
3300 36th St SE
Grand Rapids, MI 49512-2810
Phone (616) 942-2110
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614211200000",
"number": "1194286278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10897 48TH AVE BUILDING Z, APARTMENT 6, ALLENDALE, MI,",
"city": "ALLENDALE",
"state": "MI",
"postal_code": "49401",
"telephone_number": "231-590-8982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2814 WOODCLIFF CIR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495063155",
"telephone_number": "248-622-1595"
}
],
"practiceLocations": [
{
"address_1": "3300 36th St SE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495122810",
"country_code": "US",
"telephone_number": "616-942-2110",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "INGRAHAM",
"first_name": "JUSTIN",
"middle_name": "JOSEPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-29",
"last_updated": "2021-02-25",
"certification_date": "2021-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.