DEVELOPMENTAL SPECIALISTS OF SOUTHEASTERN IL, INC. (NPI# 1073628350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073628350 |
| Entity Type | Organization |
| Organization Name | DEVELOPMENTAL SPECIALISTS OF SOUTHEASTERN IL, INC. |
| Practice Address |
905 E Main St Olney IL 62450-2623 |
| Practice Telephone | 6183937732 |
| Practice Fax Number | 6183953123 |
| Mailing Telephone | 6183937732 |
| Mailing Fax Number | 6183953123 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2009-04-09 |
| Authorized Official Name | CATHERINE ROSS (PRESIDENT) |
| Authorized Official Telephone | 6183937732 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUECROSS/BLUE SHIELD IL | 8030288 | 01 |
| Street Address |
905 E MAIN ST |
| City | OLNEY |
| State | IL |
| Zip Code | 62450-2623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821531849 | Jamie Leigh Burgener | Developmental Therapist | 905 E Main St, Olney, IL 62450-2623 | 2016-11-22 |
| 1205214855 | Lindsay Overton | Developmental Therapist | 905 E Main St, Olney, IL 62450-2623 | 2015-05-15 |
| 1285979971 | Julie N Auteberry | Developmental Therapist | 905 E Main St, Olney, IL 62450-2623 | 2012-12-06 |
| 1669739140 | Megan Allen | Developmental Therapist | 905 E Main St, Olney, IL 62450-2623 | 2012-04-20 |
| 1699063826 | Debra K Coad | Physical Therapist | 905 E Main St, Olney, IL 62450-2623 | 2011-07-21 |
| 1295036275 | Hollie A Kelly | Registered Nurse | 905 E Main St, Olney, IL 62450-2623 | 2010-11-08 |
| 1548412521 | Ashley Bussard | Developmental Therapist | 905 E Main St, Olney, IL 62450-2623 | 2008-10-21 |
| 1942466925 | Rachel Leeann Yockey | Speech-Language Pathologist | 905 E Main St, Olney, IL 62450-2623 | 2008-07-30 |
| 1912170820 | Terri L Newton | Speech-Language Pathologist | 905 E Main St, Olney, IL 62450-2623 | 2008-04-11 |
| 1740467133 | Julia Ann Stover | Case Manager/Care Coordinator | 905 E Main St, Olney, IL 62450-2623 | 2008-01-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851530091 | Donna Harris | Counselor | 515 West St. John Street, Olney, IL 62450 | 2009-02-11 |
| 1942476908 | Christa Dawn Jennette | Private Vehicle | 1113 Keiffer Dr, Olney, IL 62450 | 2008-04-30 |
| 1942491162 | Marion County Horizon Center D/b/a Richland Manor | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1066 West Main St, Olney, IL 62450 | 2007-08-05 |
| 1811100407 | Advanced Open Mri, Inc. | Clinic/Center | 605 East Main Street, Olney, IL 62450 | 2007-05-08 |
| 1548489958 | Frank Edward Gruber | Dentist | 1108 N East St, Olney, IL 62450 | 2007-04-24 |
| 1508084591 | Melvin Borja Escalona | Physical Therapist | 800 East Locust St., Olney, IL 62450 | 2007-04-23 |
| 1881769826 | Jeffrey Alan Kocher | Chiropractor | 731 S West St, Olney, IL 62450 | 2006-11-22 |
| 1336211523 | Patricia Lynn Kessler Bookhout | Dentist | 1104 North East, Olney, IL 62450 | 2006-11-14 |
| 1639159015 | Bowers Drug Store Inc | Pharmacy | 205 E Main, Olney, IL 62450 | 2006-01-20 |
| 1336137199 | South Eastern Illinois Counseling Center Inc | Counselor | 504 Micah Drive, Drawer M, Olney, IL 62450 | 2005-10-06 |
| Find all providers in zip 62450 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
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| 1477171528 | Amygdala Co | Clinic/Center | 120 Hillwood Dr, Belleville, IL 62223-7159 | 2020-07-06 |
| 1689225237 | Rebecca Lynn Madden | Clinic/Center | 6331 Vv Rd, Prairie Du Rocher, IL 62277-1411 | 2019-09-25 |
| 1699238170 | Soreida Mamie Fennerr | Clinic/Center | 7729 S Loomis Blvd, Chicago, IL 60620-3751 | 2019-04-10 |
| 1710432968 | Alvin Eades Center Inc | Clinic/Center | 905 W Superior Ave, Jacksonville, IL 62650-3117 | 2016-08-17 |
| 1740649193 | Smile More Dental 3 Corp | Clinic/Center | 1480 N Orchard Rd, #104, Aurora, IL 60506-7939 | 2016-02-14 |
| 1356778823 | Dia Corporate of Illinois, Inc | Clinic/Center | 1601 Broadway Ave, Mattoon, IL 61938-4096 | 2013-09-30 |
| 1689988248 | Flying High Gymnastics, Inc | Clinic/Center | 5400 East Ave, Countryside, IL 60525-3112 | 2010-08-05 |
| 1730366154 | Move N & Cruise N Kidz LLC | Clinic/Center | 1211 Deerfield Pkwy, Apt 101, Buffalo Grove, IL 60089-4563 | 2008-01-28 |
| 1821215062 | The Arc of Iroquois County | Clinic/Center | 700 E Elm St, Watseka, IL 60970-1400 | 2007-04-19 |
| 1992708960 | Easter Seals Joliet Region Inc. | Clinic/Center | 212 Barney Dr, Joliet, IL 60435-5271 | 2005-05-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.