Healthcare Provider Details

I. General information

NPI: 1467434795
Provider Name (Legal Business Name): EASTER SEALS - UCP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E ARMSTRONG AVE
PEORIA IL
61603-3201
US

IV. Provider business mailing address

507 E ARMSTRONG AVE
PEORIA IL
61603-3201
US

V. Phone/Fax

Practice location:
  • Phone: 309-686-1777
  • Fax: 309-686-7722
Mailing address:
  • Phone: 309-686-1177
  • Fax: 309-686-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA RIDDLE
Title or Position: PRESIDENT
Credential: CPA, CGMA
Phone: 309-686-1177