Active NPI
Shannon Beeler
- Behavior Technician
- Springfield, IL
National Provider Identifier
1407428030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB538262
- Practice address
- 1815 Wildrose LN
Springfield, IL 62712-9166 - Phone
- (217) 572-7279
- NPI assigned
- Jul 13, 2021
- Sex
- Female
- Sole proprietor
- No
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 | BACB538262 | IL | Primary |
Addresses
Primary practice location
1815 Wildrose LN
Springfield, IL 62712-9166
Mailing address
2035 W Iles Ave
Springfield, IL 62704-4192
Phone (888) 308-4728
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 |
|---|---|---|---|
| BACB538262 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626134400000",
"number": "1407428030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2035 W ILES AVE",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627044192",
"telephone_number": "888-308-4728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1815 WILDROSE LN",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627129166",
"telephone_number": "217-572-7279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEELER",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-13",
"last_updated": "2021-07-13",
"certification_date": "2021-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "BACB538262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.