Shannon Mooney, BEHAVIOR SPECIALIST

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

376 5TH St
Idaho Falls, ID 83401-4762

Phone

(208) 403-1559

NPI assigned

Jul 20, 2019

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 names 1

• Shannon Gray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1563580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563580800000",
    "number": "1295388080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 5TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014762",
            "telephone_number": "208-403-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 5TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014762",
            "telephone_number": "208-403-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEY",
        "first_name": "SHANNON",
        "credential": "BEHAVIOR SPECIALIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-20",
        "last_updated": "2019-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "GRAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monticello Montessori Charter School, Inc
• Steveb John Moody, LPC
• Adam Moon, BS
• Aimee Moon, M.S., CCC-SLP
• McKenzie J Moon
• Amanda Moore, LPC
• Heather A Moore, RN
• Jared Lee Moore, PHARMD
• Kailey Lynn Moore
• Megan Marie Moore, CCC-SLP

• Developmental Disabilities Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Developmental Disabilities Clinic/Center in Idaho

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