=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134029887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BILLY SHADDEN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2026
-----------------------------------------------------
Last Update Date | 11/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1102 S ROUSE ST
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66762-6048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-231-5310
-----------------------------------------------------
Fax | 620-231-1178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3312 CLINTON PKWY
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66047-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | CERTIFICATE
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------