Elijah McGruder
Behavior Technician in Leavenworth, KS. Individual provider (NPI-1).
NPI number1063201564
StatusActive
Last updated in NPPESMay 2, 2025
Details
- NPI
- 1063201564
- Entity type
- Individual (NPI-1)
- Name
- Elijah McGruder
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 2, 2025
- Certification date
- May 2, 2025
- Last updated
- May 2, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
1719 Metropolitan AveLeavenworth, KS 66048-1124
Phone 913-250-5634
Mailing address
5863 Nw 72nd StKansas City, MO 64151-1483
Phone 913-250-5634
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 176 Behavior Technician providers in Leavenworth · All 1,312 providers in Leavenworth
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