Active NPI
Angie Schuckenbrock
- Dental Hygienist
- Gillespie, IL
National Provider Identifier
1508729047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 020011598
- Practice address
- 109 E Maple St
Gillespie, IL 62033-1473 - Phone
- (217) 839-4110
- NPI assigned
- Dec 3, 2025
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 020011598 | IL | Primary |
Addresses
Primary practice location
109 E Maple St
Gillespie, IL 62033-1473
Mailing address
9508 Spanish Needle Rd
Gillespie, IL 62033-3397
Phone (217) 839-4110
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 |
|---|---|---|---|
| 020011598 | IL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1764720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764720000000",
"number": "1508729047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9508 SPANISH NEEDLE RD",
"city": "GILLESPIE",
"state": "IL",
"postal_code": "620333397",
"telephone_number": "217-839-4110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 E MAPLE ST",
"city": "GILLESPIE",
"state": "IL",
"postal_code": "620331473",
"telephone_number": "217-839-4110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHUCKENBROCK",
"first_name": "ANGIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-12-03",
"last_updated": "2025-12-03",
"certification_date": "2025-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "IL",
"license": "020011598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gillespie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.