Idjj SD#428

Primary specialty

School PsychologistTaxonomy code 103TS0200X

Legal business name

IDJJ SD#428

Practice address

1220 Centreville Ave FL 2
Belleville, IL 62220-3089

Phone

(618) 222-3148

NPI assigned

Nov 20, 2019

Last updated

Nov 20, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bambi Bethel-Leitschuh

Title

Director of Special Education

Phone

(618) 222-3148

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1255977757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 CENTREVILLE AVE FL 2",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622203089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 CENTREVILLE AVE FL 2",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622203089",
            "telephone_number": "618-222-3148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDJJ SD#428",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "BETHEL-LEITSCHUH",
        "authorized_official_first_name": "BAMBI",
        "authorized_official_title_or_position": "DIRECTOR OF SPECIAL EDUCATION",
        "authorized_official_telephone_number": "618-222-3148"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• School Psychologist in Belleville, IL
• Providers in Belleville, IL by specialty
• School Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; 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.