Provider Demographics
NPI:1336511880
Name:OPERANT: SPEECH, LANGUAGE, AND BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:OPERANT: SPEECH, LANGUAGE, AND BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SCHAPER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, BCBA
Authorized Official - Phone:618-697-2138
Mailing Address - Street 1:945 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:COBDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62920-3443
Mailing Address - Country:US
Mailing Address - Phone:618-697-2138
Mailing Address - Fax:
Practice Address - Street 1:945 BLUEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:COBDEN
Practice Address - State:IL
Practice Address - Zip Code:62920-3443
Practice Address - Country:US
Practice Address - Phone:618-697-2138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL146007980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL496661150001Medicaid