Desiree Ann Self, MS

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

244 S Silverwood Way
Eagle, ID 83616-6165

Phone

(440) 228-7161

NPI assigned

Jul 12, 2021

Last updated

Jul 12, 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1528630357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 S SILVERWOOD WAY",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166165",
            "telephone_number": "440-228-7161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 S SILVERWOOD WAY",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166165",
            "telephone_number": "440-228-7161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "DESIREE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Andrew Scott, DO
• Christopher J Seagrave, PT, SCS, ATC, CSCS
• Seagull Home Health, LLC
• Seagull Hospice, LLC
• Alexis Ann Searle, OT
• Sensory Bin Pediatric Therapy Clinic, PLLC
• Janet Louise Sermon, DC
• Alex Servatius, PHARMD
• Michael John Seyler, D.D.S.
• Justina Sgorbissa

• Behavior Technician in Eagle, ID
• Providers in Eagle, ID by specialty
• Behavior Technician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.