Active NPI
Mallory Bopp
- Behavior Technician
- Springfield, IL
National Provider Identifier
1427799592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 7720-33-5709
- Practice address
- 3921 Pintail Dr
Springfield, IL 62711-6738 - Phone
- (217) 553-8243
- NPI assigned
- Apr 5, 2022
- Last updated
- Apr 5, 2022
- 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 | 7720-33-5709 | IN | Primary |
Addresses
Primary practice location
3921 Pintail Dr
Springfield, IL 62711-6738
Mailing address
3921 Pintail Dr
Springfield, IL 62711-6738
Phone (217) 553-8243
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649116800000",
"number": "1427799592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3921 PINTAIL DR",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627116738",
"telephone_number": "217-553-8243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3921 PINTAIL DR",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627116738",
"telephone_number": "217-553-8243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOPP",
"first_name": "MALLORY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2022-04-05",
"certification_date": "2022-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "7720-33-5709",
"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 Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.