Makayla Virginia Rose Bauer
Individual provider Active NPI Behavior Technician · Edwardsville, IL
NPI 1699463562 · NPPES record last updated Apr 27, 2023
Key facts
- NPI
- 1699463562
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 400 Saint Louis St Ste 1
Edwardsville, IL 62025-1979 - Phone
- (618) 226-4397
- NPI assigned
- Apr 27, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
400 Saint Louis St Ste 1
Edwardsville, IL 62025-1979
Mailing address
2566 Parkview Dr Apt 3
Granite City, IL 62040-8208
Phone (217) 461-2531
Other providers in Edwardsville, IL
- Valerie J Barber
- Cara Anne Barker
- Janet Elaine Barker
- Lucas James Barrett
- Stacey Marie Bast
- Ahmad Hassan Baydoun
- Drew T Beachy
- Tessa Lee Beard
- Jamie Nicole Beatty
- Michael Edward Beatty
All providers in Edwardsville, IL · Behavior Technician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.