Active NPI
Ehrica D Reaktenwalt
- Early Intervention Provider Agency
- Mackinaw, IL
National Provider Identifier
1780979351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Early Intervention Provider Agency
- Practice address
- 206 S Main St
Box 596
Mackinaw, IL 61755-7511 - Phone
- (309) 258-1601
- NPI assigned
- Jun 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | Primary |
Addresses
Primary practice location
206 S Main St
Box 596
Mackinaw, IL 61755-7511
Mailing address
206 S Main St
Box 596
Mackinaw, IL 61755-7511
Phone (309) 258-1601
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307836800000",
"number": "1780979351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 S MAIN ST",
"address_2": "BOX 596",
"city": "MACKINAW",
"state": "IL",
"postal_code": "617557511",
"telephone_number": "309-258-1601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 S MAIN ST",
"address_2": "BOX 596",
"city": "MACKINAW",
"state": "IL",
"postal_code": "617557511",
"telephone_number": "309-258-1601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAKTENWALT",
"first_name": "EHRICA",
"middle_name": "D",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-12",
"last_updated": "2011-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mackinaw, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.