Active NPI
Jacklyn Tanis
- Behavior Technician
- Merrillville, IN
National Provider Identifier
1295210508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 8200 Georgia St
Merrillville, IN 46410-6227 - Phone
- (219) 791-1400
- NPI assigned
- Oct 2, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
8200 Georgia St
Merrillville, IN 46410-6227
Mailing address
126 E Main Ave
Zeeland, MI 49464-1736
Phone (616) 900-5001
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Equitable Learning Solutions | Current | Accepting new patients | |
| Innovations in Learning, PC | Behavior Technician | Past | Accepting new patients |
Locations
126 E Main Ave
Zeeland, MI 49464
Phone (616) 826-7218
Organizations & group practices 2
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.
-
- Behavior Analyst
- Zeeland, MI
- NPI 1538732714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706745600000",
"number": "1295210508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 E MAIN AVE",
"city": "ZEELAND",
"state": "MI",
"postal_code": "494641736",
"telephone_number": "616-900-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 GEORGIA ST",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464106227",
"telephone_number": "219-791-1400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANIS",
"first_name": "JACKLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-02",
"last_updated": "2024-02-01",
"certification_date": "2024-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.