Active NPI
McKenna Marie Speed
- Behavior Technician
- Grand Rapids, MI
National Provider Identifier
1891419396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 120 Stevens St SW
Grand Rapids, MI 49507-1526 - Phone
- (855) 832-6727
- NPI assigned
- Sep 28, 2022
- 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 | Primary |
Addresses
Primary practice location
120 Stevens St SW
Grand Rapids, MI 49507-1526
Mailing address
4967 Pierce St Apt 1322
Allendale, MI 49401-8261
Phone (586) 659-4955
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81-0764147 | Medicaid | MI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.teampbs.com |
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": "1664323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1891419396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4967 PIERCE ST APT 1322",
"city": "ALLENDALE",
"state": "MI",
"postal_code": "494018261",
"telephone_number": "586-659-4955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 STEVENS ST SW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495071526",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPEED",
"first_name": "MCKENNA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-28",
"last_updated": "2022-09-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "81-0764147",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.teampbs.com",
"affiliation": "N",
"address_1": "120 Stevens St SW",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495071526",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.