Shawnee Behavioral Consultation LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1084838 Issued in IL

Legal business name

SHAWNEE BEHAVIORAL CONSULTATION LLC

Practice address

224 Belden Dr
Edwardsville, IL 62025-3178

Phone

(618) 977-2773

Fax

(312) 626-2429

NPI assigned

Jan 11, 2012

Organization subpart

No

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

Authorized official

Name

Christina Ann Ruzicka, M.S., BCBA

Title

Board Certified Behavior Analyst

Phone

(618) 977-2773

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Megan Elizabeth Ballor

  • Behavior Analyst
  • Clayton, MO
  • NPI 1366957235
  NPD (past)

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

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1356611024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7384 SHARP AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631163040",
            "telephone_number": "618-977-2773",
            "fax_number": "312-626-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 BELDEN DR",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253178",
            "telephone_number": "618-977-2773",
            "fax_number": "312-626-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE BEHAVIORAL CONSULTATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "RUZICKA",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BOARD CERTIFIED BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "618-977-2773",
        "authorized_official_credential": "M.S., BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1084838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Nichole Sell, RN, SRNA
• Lindsay Serrano, LCPC
• Chairo Shaffer, COTA/L
• Vipinchandra K Shah
• Taylor Paris Sharp, RN, BSN
• Gabriela Shea
• Brian Shin, DDS
• Signature Endodontics
• Amanda Sile
• Hannah M Simpson, RNC-BSN

• Behavior Analyst in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.