Active NPI
Jakia Douglas
- Behavior Technician
- O'Fallon, IL
National Provider Identifier
1740752369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- D242-4329-9873
- Practice address
- 634 N Main St Ste 4
O Fallon, IL 62269-3746 - Phone
- (618) 726-0701
- NPI assigned
- Dec 20, 2018
- Last updated
- Dec 20, 2018
- 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 | D242-4329-9873 | IL | Primary |
Addresses
Primary practice location
634 N Main St Ste 4
O Fallon, IL 62269-3746
Mailing address
21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807
Phone (818) 345-2345
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 |
|---|---|---|---|
| D242-4329-9873 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545264000000",
"number": "1740752369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21600 OXNARD ST STE 1800",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913677807",
"telephone_number": "818-345-2345",
"fax_number": "000-000-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "634 N MAIN ST STE 4",
"city": "O FALLON",
"state": "IL",
"postal_code": "622693746",
"telephone_number": "618-726-0701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "JAKIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-20",
"last_updated": "2018-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "D242-4329-9873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.