Madison Amanda Gatz, RBT-18-48805

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-18-48805 Issued in IL

Practice address

1853 Woodlawn Rd
Steward, IL 60553-9755

Phone

(815) 901-5126

NPI assigned

May 15, 2018

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 15, 2018.

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1992295034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1853 WOODLAWN RD",
            "city": "STEWARD",
            "state": "IL",
            "postal_code": "605539755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1853 WOODLAWN RD",
            "city": "STEWARD",
            "state": "IL",
            "postal_code": "605539755",
            "telephone_number": "815-901-5126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATZ",
        "first_name": "MADISON",
        "middle_name": "AMANDA",
        "credential": "RBT-18-48805",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "RBT-18-48805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bailey Johnson, BSN CLC
• Nicole Kedzie, CPM
• Steward District 220

• All providers in Steward, IL
• Behavior Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.