Caleb Ryan Stanley

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-17-24990 Issued in IL

Practice address

4114 N Water Tower PL Ste C
Mount Vernon, IL 62864-6548

Phone

(662) 882-8116

NPI assigned

Jul 11, 2018

Last updated

Jul 11, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1531267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1336625508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4294 BOSKYDELL RD",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629037611",
            "telephone_number": "662-882-8116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4114 N WATER TOWER PL STE C",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646548",
            "telephone_number": "662-882-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANLEY",
        "first_name": "CALEB",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-11",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1-17-24990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SSC Mount Vernon Operating Company LLC (Nature Trail Health Care Center)
• SSM Health Businesses (SSM Health at Home Hospice Glen Carbon)
• SSM Health Businesses (SSM Health at Home Home Health Glen Carbon)
• St. Louis JC Vamc
• Maranda Anne Stachyra, MSW, LCSW
• Leeann Stanley, PT
• Jennifer Lynn Starr, FNP-C
• Andrea Stearns, NP
• Mary L. Stedelin, PT
• Martin Jay Stephens, BC-HIS

• Behavior Analyst in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.