Individual provider Active NPI

Renauda Brown

  • Behavior Technician
  • Fairview Heights, IL
National Provider Identifier
1790477446
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
343 Fountains Pkwy Unit 201
Fairview Heights, IL 62208-2170
Phone
(618) 515-1441
Fax
(618) 551-4711
NPI assigned
May 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

343 Fountains Pkwy Unit 201
Fairview Heights, IL 62208-2170

Mailing address

343 Fountains Pkwy Unit 201
Fairview Heights, IL 62208-2170
Phone (618) 515-1441

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": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1790477446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 FOUNTAINS PKWY UNIT 201",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082170",
            "telephone_number": "618-515-1441",
            "fax_number": "618-551-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 FOUNTAINS PKWY UNIT 201",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082170",
            "telephone_number": "618-515-1441",
            "fax_number": "618-551-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "RENAUDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.