Active NPI
Jennifer Renee Sullivan
- Behavior Analyst
- Bloomington, IL
National Provider Identifier
1902049653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 0-07-2352
- Practice address
- 2416 E Washington St
Suite G
Bloomington, IL 61704-4472 - Phone
- (309) 662-5050
- NPI assigned
- Apr 10, 2009
- 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 Analyst | 103K00000X | 0-07-2352 | IL | Primary |
Addresses
Primary practice location
2416 E Washington St
Suite G
Bloomington, IL 61704-4472
Mailing address
4634 Circle Dr
Heyworth, IL 61745-9462
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": "1239321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239321600000",
"number": "1902049653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4634 CIRCLE DR",
"city": "HEYWORTH",
"state": "IL",
"postal_code": "617459462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2416 E WASHINGTON ST",
"address_2": "SUITE G",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617044472",
"telephone_number": "309-662-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JENNIFER",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-10",
"last_updated": "2009-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IL",
"license": "0-07-2352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.