JACK KELLY (NPI# 1396383030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396383030 |
| Entity Type | Individual |
| Full Name | JACK KELLY |
| Practice Address |
1975 Mcdowell Rd. #101 Naperville IL 60563 |
| Mailing Address |
2139 W Touhy Ave Chicago IL 60645-3505 |
| Practice Telephone | 3312298839 |
| Mailing Telephone | 7733864024 |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2019-12-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106E00000X | Assistant Behavior Analyst | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073137998 | Jack E Kelly | Physical Medicine & Rehabilitation | 10701 East Blvd, Cleveland, OH 44106-1702 | 2020-06-05 |
| 1679032452 | Jack Kelly | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2019-03-19 |
| Street Address |
1975 MCDOWELL RD. #101 |
| City | NAPERVILLE |
| State | IL |
| Zip Code | 60563 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902884 | Julia Ann Gottschalk | Nurse Practitioner | 1979 Mcdowell Rd, Unit 103, Naperville, IL 60563 | 2020-11-06 |
| 1700484847 | Lee Michael Harms I | Social Worker | 1952 Mcdowell Road, Suite 305, Naperville, IL 60563 | 2020-10-12 |
| 1881208478 | Poornima Swamy Gangaji | Dentist | 760 N, Illinois Rte 59, Ste100, Naperville, IL 60563 | 2020-09-01 |
| 1851901219 | Adiana Lebron | Social Worker | 2948 Artestian Road, Naperville, IL 60563 | 2020-07-31 |
| 1194342014 | Ingrid Lara | Behavioral Analyst | 1975 Mcdowell Rd #101, Naperville, IL 60563 | 2020-06-26 |
| 1316583529 | Arvind Ramakrishnan | Behavioral Analyst | 1975 Mcdowell Rd., Naperville, IL 60563 | 2019-11-22 |
| 1679115778 | Melissa Macias | Behavioral Analyst | 1975 Mcdowell Road, #101, Naperville, IL 60563 | 2019-10-10 |
| 1629619275 | Meghann Reid Vizintos | Physician Assistant | 1763 Freedom Dr Ste 117, Naperville, IL 60563 | 2019-10-04 |
| 1417413543 | Vikram Singh Cheema | Physician Assistant | 1335 North Mill Street, Naperville, IL 60563 | 2019-02-13 |
| 1386118057 | Derick Dermatology, LLC | Non-Pharmacy Dispensing Site | 263 Shuman Boulevard, Suite 125, Naperville, IL 60563 | 2019-01-16 |
| Find all providers in zip 60563 | ||||
| Taxonomy Code | 106E00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Assistant Behavior Analyst |
| An assistant behavior analyst is qualified by Behavior Analyst Certification Board certification and/or a state-issued license or credential in behavior analysis to practice under the supervision of an appropriately credentialed professional behavior analyst. An assistant behavior analyst delivers services consistent with the dimensions of applied behavior analysis and supervision requirements defined in state laws or regulations and/or national certification standards. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing behavior-analytic treatment plans, training and supervising others in implementation of components of treatment plans, and direct implementation of treatment plans. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689164592 | Christina Marie Lies | Assistant Behavior Analyst | 603 E Diehl Rd Ste 123, Naperville, IL 60563-4908 | 2018-05-16 |
| 1730631359 | Courtney Tidwell | Assistant Behavior Analyst | 1280 Iroquois Ave, Suite 402, Naperville, IL 60563-8551 | 2016-10-31 |
| 1982156576 | Colleen Houda | Assistant Behavior Analyst | 1280 Iroquois Ave Ste 402, Naperville, IL 60563-8570 | 2016-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891326773 | Berikisu Atojoko | Assistant Behavior Analyst | 2953 Old Renwick Cir, Plainfield, IL 60544-2246 | 2020-01-30 |
| 1679113948 | Tiffany Zenisek | Assistant Behavior Analyst | 133 Boulder Hill Pass, Montgomery, IL 60538-2325 | 2020-01-14 |
| 1285273805 | Samantha Weyman | Assistant Behavior Analyst | 119 S Harvey Ave, Oak Park, IL 60302-2703 | 2019-12-30 |
| 1427692201 | Cynthia Mrotek | Assistant Behavior Analyst | 13071 Dunmoor Dr, Lemont, IL 60439-2741 | 2019-11-04 |
| 1518425644 | Nancy R Huffman | Assistant Behavior Analyst | 4224 Lincolnshire Dr Ste A, Mount Vernon, IL 62864-2156 | 2019-03-07 |
| 1194298158 | Kirsten Luna | Assistant Behavior Analyst | 8448 Karlov Ave, Skokie, IL 60076-2103 | 2019-01-02 |
| 1982176285 | Anita Lomax | Assistant Behavior Analyst | 206 E Washington St Apt A, Joliet, IL 60433-1006 | 2018-12-26 |
| 1285118414 | Ashley Marie Walsh | Assistant Behavior Analyst | 9510 Saint Clair Ave, Fairview Heights, IL 62208-1639 | 2018-09-24 |
| 1790264927 | Independent With Autism | Assistant Behavior Analyst | 100 Saunders Rd Ste 150, Lake Forest, IL 60045-2526 | 2018-08-08 |
| 1215413224 | Bravo Behavioral Health LLC | Assistant Behavior Analyst | 8140 Mccormick Blvd Ste 141, Skokie, IL 60076-2920 | 2018-07-12 |
| Find all providers with the same taxonomy | ||||
| City | NAPERVILLE |
| Zip Code | 60563 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.