MEDICARE: SHAUREAYE WASHINGTON 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	RBT-23-314369	IL

General Provider Information

NPI Number	:	1669351797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUREAYE WASHINGTON RBT

Provider Business Mailing Address
First Line	:	1265 DIVISION ST
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 DIVISION ST
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2421
Country	:	US
Telephone Number	:	773-426-5584
Fax Number	:

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

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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Directions to “ SHAUREAYE WASHINGTON RBT” Practice Location

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