Active NPI
Angela Moore
- Behavior Technician
- Genoa, IL
National Provider Identifier
1992256309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 519 W 2ND St
Genoa, IL 60135-1058 - Phone
- (815) 517-3101
- NPI assigned
- Oct 20, 2016
- Last updated
- Jul 22, 2025
- 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 | IL | Primary |
Addresses
Primary practice location
519 W 2ND St
Genoa, IL 60135-1058
Mailing address
507 W Main St Apt 1
Kirkland, IL 60146-8453
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588395362 | Medicaid | IL |
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": "1476921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753142400000",
"number": "1992256309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 W MAIN ST APT 1",
"city": "KIRKLAND",
"state": "IL",
"postal_code": "601468453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 W 2ND ST",
"city": "GENOA",
"state": "IL",
"postal_code": "601351058",
"telephone_number": "815-517-3101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "ANGELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-20",
"last_updated": "2025-07-22",
"certification_date": "2025-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1588395362",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Genoa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.