Stacy Braddy

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-24-394101 Issued in IL

Practice address

1319 N Galena Ave
Dixon, IL 61021-1009

Phone

(815) 440-6134

Fax

(855) 620-0303

NPI assigned

Nov 21, 2024

Last updated

Nov 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Autism Center of Sauk Valley, PLLC

  dba Autism Center of Illinois

  • Multi-Specialty Clinic/Center
  • Dixon, IL
  • NPI 1881380814

  Behavior Technician

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1811712045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 N GALENA AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211009",
            "telephone_number": "815-440-6134",
            "fax_number": "855-620-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 N GALENA AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211009",
            "telephone_number": "815-440-6134",
            "fax_number": "855-620-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDY",
        "first_name": "STACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-21",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "RBT-24-394101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Bond
• Stacey Marie Bontz, LCPC
• Alison Boothe, LCSW
• Amy Jean Boss, M.A. CCC SLP
• Deb A Bowers, LPTA
• Tyrone Robert Brand, M.D.
• Xaviera Danielle Brierre, MD
• Amanda Kay Briese
• Gabriella Tatiana Brigando, DMD, MBS
• Rebecka D Brinkmann, LPTA

• Behavior Technician in Dixon, IL
• Providers in Dixon, IL by specialty
• Behavior Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.