MEDICARE: SHIANNA EVERSON BCBA

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	103K00000X	Behavior Analyst	RBT-19-94099	WI
2	103K00000X	Behavior Analyst	505-140	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-09-94099	OTHER	WI	RBT #

General Provider Information

NPI Number	:	1295304236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIANNA EVERSON BCBA

Provider Business Mailing Address
First Line	:	4500 INDUSTRIAL PARK RD
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-5014
Country	:	US
Telephone Number	:	715-544-6847
Fax Number	:	715-600-9046

Provider Business Practice Location Address
First Line	:	2822 W CUCHARRAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2448
Country	:	US
Telephone Number	:	715-544-6847
Fax Number	:	715-600-9046

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

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	03/28/2025

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Directions to “ SHIANNA EVERSON BCBA” Practice Location

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