Active NPI
Avia N Wideman
- Behavior Analyst
- Shorewood, IL
National Provider Identifier
1558227488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 152.003279
- Practice address
- 850 Brook Forest Ave
Shorewood, IL 60404-8513 - Phone
- (779) 235-4639
- NPI assigned
- Jan 5, 2026
- Last updated
- Jan 19, 2026
- 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 Analyst | 103K00000X | 152.003279 | IL | Primary |
Addresses
Primary practice location
850 Brook Forest Ave
Shorewood, IL 60404-8513
Mailing address
850 Brook Forest Ave
Shorewood, IL 60404-8513
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 |
|---|---|---|---|
| 152.003279 | IL | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1767571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768780800000",
"number": "1558227488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 BROOK FOREST AVE",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604048513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 BROOK FOREST AVE",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604048513",
"telephone_number": "779-235-4639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDEMAN",
"first_name": "AVIA",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-01-05",
"last_updated": "2026-01-19",
"certification_date": "2026-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IL",
"license": "152.003279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.