Active NPI
Leilani Anise Wedgle, RBT
- Behavior Technician
- Colorado Springs, CO
National Provider Identifier
1194425397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 17-093-7386
- Practice address
- 3595 E Fountain Blvd Ste 145
Colorado Springs, CO 80910-1791 - Phone
- (254) 630-1578
- NPI assigned
- Mar 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CO | ||
| Behavior Technician | 106S00000X | 17-093-7386 | CO | Primary |
Addresses
Primary practice location
3595 E Fountain Blvd Ste 145
Colorado Springs, CO 80910-1791
Mailing address
2524 San Marcos Dr
Colorado Springs, CO 80910-1242
Phone (719) 447-7938
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 |
|---|---|---|---|
| 17-093-7386 | CO | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678060800000",
"number": "1194425397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2524 SAN MARCOS DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809101242",
"telephone_number": "719-447-7938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3595 E FOUNTAIN BLVD STE 145",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809101791",
"telephone_number": "254-630-1578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEDGLE",
"first_name": "LEILANI",
"middle_name": "ANISE",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-06",
"last_updated": "2023-03-06",
"certification_date": "2023-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "17-093-7386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.