Active NPI
Shakithy Derae Wilson
- Behavior Technician
- Crown Point, IN
National Provider Identifier
1306713441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-25-481215
- Practice address
- 205 W Franciscan Dr
Crown Point, IN 46307-4802 - Phone
- (888) 998-5269
- NPI assigned
- Oct 22, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 | RBT-25-481215 | IN | Primary |
Addresses
Primary practice location
205 W Franciscan Dr
Crown Point, IN 46307-4802
Mailing address
3641 Madison St
Gary, IN 46408-1665
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 |
|---|---|---|---|
| RBT-25-481215 | IN | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1306713441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3641 MADISON ST",
"city": "GARY",
"state": "IN",
"postal_code": "464081665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 W FRANCISCAN DR",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463074802",
"telephone_number": "888-998-5269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHAKITHY",
"middle_name": "DERAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-10-22",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "IN",
"license": "RBT-25-481215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crown Point, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.