Healthcare Provider Details

I. General information

NPI: 1720939507
Provider Name (Legal Business Name): FIRST ADVANTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 OAKDALE ST
SPRINGFIELD IL
62703-2045
US

IV. Provider business mailing address

1209 OAKDALE ST
SPRINGFIELD IL
62703-2045
US

V. Phone/Fax

Practice location:
  • Phone: 217-836-5775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: RANIYAH DOWDELL
Title or Position: BEHAVIORAL TECHNICIAN
Credential:
Phone: 217-836-5775