MEDICARE: SHERANGELIA RAICHEL MCCLAIN

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

General Provider Information

NPI Number	:	1841165925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERANGELIA RAICHEL MCCLAIN

Provider Business Mailing Address
First Line	:	1400 N 2ND ST
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-4212
Country	:	US
Telephone Number	:	314-319-9916
Fax Number	:	314-319-9916

Provider Business Practice Location Address
First Line	:	1400 N 2ND ST
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-4212
Country	:	US
Telephone Number	:	314-319-9916
Fax Number	:	314-319-9916

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

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/27/2025

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