MEDICARE: ADAJEE JANAY BANKS RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063000891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAJEE JANAY BANKS RBT

Provider Business Mailing Address
First Line	:	5220 6TH STREET FRONTAGE RD E STE 1700
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-5771
Country	:	US
Telephone Number	:	217-525-8332
Fax Number	:

Provider Business Practice Location Address
First Line	:	7674 PLUMMER BUSINESS DR
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-7604
Country	:	US
Telephone Number	:	314-275-0506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	08/14/2023

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