Active NPI
Alyssa Ann Pruemer
- Developmental Therapist
- Shumway, IL
National Provider Identifier
1376714964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 2322901
- Practice address
- 20445 N 1060TH St
Shumway, IL 62461-2250 - Phone
- (219) 690-3983
- NPI assigned
- Mar 21, 2008
- Last updated
- Mar 21, 2008
- 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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 2322901 | IL | Primary |
Addresses
Primary practice location
20445 N 1060TH St
Shumway, IL 62461-2250
Mailing address
20445 N 1060TH St
Shumway, IL 62461-2250
Phone (219) 690-3983
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 |
|---|---|---|---|
| 2322901 | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206057600000",
"number": "1376714964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20445 N 1060TH ST",
"city": "SHUMWAY",
"state": "IL",
"postal_code": "624612250",
"telephone_number": "219-690-3983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20445 N 1060TH ST",
"city": "SHUMWAY",
"state": "IL",
"postal_code": "624612250",
"telephone_number": "219-690-3983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUEMER",
"first_name": "ALYSSA",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-21",
"last_updated": "2008-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "2322901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shumway, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.