Juanakeisha Wilson, RBT 16-24410
Individual provider Active NPI Behavior Technician · Riverdale, IL
NPI 1306337522 · NPPES record last updated May 23, 2018
Key facts
- NPI
- 1306337522
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 16-24410 (IL)
- Practice address
- 14104 S Wabash Ave
Riverdale, IL 60827-2236 - Phone
- (630) 728-1991
- NPI assigned
- May 23, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-24410 | IL | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 16-24410 | IL | Yes |
Addresses
Primary practice location
14104 S Wabash Ave
Riverdale, IL 60827-2236
Mailing address
14104 S Wabash Ave
Riverdale, IL 60827-2236
Other providers in Riverdale, IL
- Renee Vaughn-Bell
- Erica Keanna Warren-Spears
- Janiasha Washington
- Patricia Jean Wilkening
- Ceneice Williams
All providers in Riverdale, IL · Behavior Technician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.