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NPI Code Detail

MEDICARE: DESTINY NEWSOM

MEDICARE: DESTINY NEWSOM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianIL

General Provider Information

NPI Number : 1245197086
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY NEWSOM
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 332 S MICHIGAN AVE STE 900
Second Line :
City : CHICAGO
State : IL
Zip : 60604-4393
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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Directions to “ DESTINY NEWSOM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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