Provider Demographics
NPI:1669164778
Name:SHIELDS, MAKAYLA JANE (RBT)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:JANE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:RBT
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Other - Credentials:
Mailing Address - Street 1:P.O. DRAWER 2109
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-2109
Mailing Address - Country:US
Mailing Address - Phone:479-967-2322
Mailing Address - Fax:479-967-2876
Practice Address - Street 1:212 S LINCOLN ST STE A
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9722
Practice Address - Country:US
Practice Address - Phone:479-770-0744
Practice Address - Fax:479-770-0176
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician