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General NPI Number Information
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NPI Number | 1942187661
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Entity Type | Organization
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Legal Business Name | SPECTRUM SHINES
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 2201 SIENNA DR
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City | JOLIET
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State | IL
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Zip | 60431-8590
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Country | US
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Telephone | 815-546-4839
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 W GALENA BLVD
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City | AURORA
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State | IL
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Zip | 60506-4305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRITTNEY BLACKAMORE
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Credential | BCBA
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Telephone | 815-546-4839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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