Carissa Shoultz, RBT-17-38260

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-49774 Issued in IL

Practice address

2602 N Saint Louis Ave # 3
Chicago, IL 60647-1216

Phone

(608) 345-2474

NPI assigned

May 9, 2018

Last updated

Jun 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1396234894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2602 N SAINT LOUIS AVE # 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471216",
            "telephone_number": "608-345-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 N SAINT LOUIS AVE # 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471216",
            "telephone_number": "608-345-2474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOULTZ",
        "first_name": "CARISSA",
        "credential": "RBT-17-38260",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-09",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1-21-49774",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "17-38260",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.