Raven Shaw, Behavior Technician
Behavior Technician in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1194590232
StatusActive
Last updated in NPPESNov 22, 2024
Details
- NPI
- 1194590232
- Entity type
- Individual (NPI-1)
- Name
- Raven Shaw
- Credential
- Behavior Technician
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 20, 2023
- Certification date
- Nov 22, 2024
- Last updated
- Nov 22, 2024
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
3809 Lake Eastbrook Blvd SeGrand Rapids, MI 49546-5931
Phone 616-604-8492
Mailing address
3809 Lake Eastbrook Blvd SeGrand Rapids, MI 49546-5931
Phone 616-604-8493
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 1,949 Behavior Technician providers in Grand Rapids · All 20,987 providers in Grand Rapids
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