Healthcare Provider Details

I. General information

NPI: 1619800240
Provider Name (Legal Business Name): JARED SCHONERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 E ELDORADO ST
DECATUR IL
62521-1915
US

IV. Provider business mailing address

PO BOX 745
SALEM IL
62881-0745
US

V. Phone/Fax

Practice location:
  • Phone: 217-474-5993
  • Fax:
Mailing address:
  • Phone: 217-474-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: