KELLY LARSON (NPI# 1184282212) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184282212 |
| Entity Type | Individual |
| Full Name | KELLY LARSON |
| Practice Address |
3504 Commercial Ave Northbrook IL 60062-1821 |
| Practice Telephone | 2244589797 |
| Mailing Telephone | 2244589797 |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2019-06-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106E00000X | Assistant Behavior Analyst | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 36-123419 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386055168 | Kelly Larson | Case Manager/Care Coordinator | 6809 Bebe Ct., Louisville, KY 40219 | 2014-05-14 |
| 1124442595 | Kelly Larson | Massage Therapist | 11 Spokane St Ste 202, Wenatchee, WA 98801-6132 | 2014-02-06 |
| 1619274362 | Kelly A Larson | Massage Therapist | 225 Maxwell Ave, Port Townsend, WA 98368-9488 | 2011-02-15 |
| 1346310414 | Kelly James Larson | Dentist | 8086 E Florentine Rd, Prescott Valley, AZ 86314-9422 | 2006-11-08 |
| 1023191442 | Kelly Suzanne Larson | Family Medicine | 700 Lily Rd Se, Olympia, WA 98503 | 2006-10-21 |
| 1144691551 | Kelly Elizabeth Larson | Behavioral Analyst | 1025 E 54th St, Indianapolis, IN 46220-3219 | 2015-10-12 |
| 1891101606 | Kelly Larson | Counselor | 7907 Ostrow St, San Diego, CA 92111-3635 | 2014-07-01 |
| 1528190998 | Kelly Larson | Physical Therapy Assistant | 1301 15th Ave W, Williston, ND 58801-3821 | 2007-03-12 |
| 1760512438 | Kelly Marie Larson | Physical Therapist | 10300 W 103rd St, Suite 300, Overland Park, KS 66214-2642 | 2007-03-06 |
| 1548301161 | Kelly Larson | Speech-Language Pathologist | 701 W 6th St, Grafton, ND 58237-1379 | 2007-02-08 |
| Street Address |
3504 COMMERCIAL AVE |
| City | NORTHBROOK |
| State | IL |
| Zip Code | 60062-1821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174746432 | Kimberly J. Berenberg | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2007-04-11 |
| 1730798588 | Aileen Tobias | Behavior Technician | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2020-07-28 |
| 1982257374 | Natalie Wolfe | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2019-07-24 |
| 1083179576 | Kylene Henthorn | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2019-02-08 |
| 1871058644 | Rebecca Rae De Rosa | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2019-02-06 |
| 1811436561 | Julie Brannen | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2017-02-14 |
| 1942671599 | Detelina Coons | Behavioral Analyst | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2015-10-08 |
| 1992184295 | Helen Maritim-adipo | Behavioral Analyst | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2015-05-20 |
| 1013257658 | Lindsay Anne Stuart | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2013-02-19 |
| 1083964381 | Katherine Rose Kennedy Barry | Counselor | 3504 Commercial Ave, Northbrook, IL 60062-1821 | 2012-09-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487067 | Cvs Aoc Services, L.L.C. | Optometrist | 936 Willow Road, Store 0141, Northbrook, IL 60062 | 2020-05-06 |
| 1386103885 | Jennifer Venegas | Behavior Technician | 5 Revere Dr Suit 120, Northbrook, IL 60062 | 2019-03-14 |
| 1720558281 | Taylor Hundley | Behavior Technician | 5 Revere Dr. Suite 120, Northbrook, IL 60062 | 2018-11-27 |
| 1609344027 | Melissa Cepeda | Behavior Technician | 5 Revere Dr Suite 120, Northbrook, IL 60062 | 2018-11-03 |
| 1235606658 | Candace Cheyenne Kaiser | Behavior Technician | 5 Revere Dr, Suite 120, Northbrook, IL 60062 | 2018-10-24 |
| 1275058745 | The Renfrew Center of Illinois | Counselor | 5 Revere Dr, Suite 100, Northbrook, IL 60062 | 2017-08-07 |
| 1467984773 | Ayzenshteyn Chiropractic | Chiropractor | 3210 Doolittle Dr., Northbrook, IL 60062 | 2017-03-28 |
| 1396282695 | Josephine Driscoll | Physician Assistant | 400 Skokie Blvd., Suite 450, Northbrook, IL 60062 | 2017-01-24 |
| 1396297842 | Lauren Raphael Lcsw LLC | Social Worker | 3050 Pheasant Creek Drive, Apt. 104, Northbrook, IL 60062 | 2016-11-01 |
| 1851847073 | Jassim Vailoces | Physical Therapist | 634 Academy Dr, Northbrook, IL 60062 | 2016-08-28 |
| Find all providers in zip 60062 | ||||
| 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 |
|---|---|---|---|---|
| 1346860178 | Leann Staseck | Assistant Behavior Analyst | 5 Revere Dr Ste 120, Northbrook, IL 60062-8005 | 2020-04-22 |
| 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 |
| 1396383030 | Jack Kelly | Assistant Behavior Analyst | 1975 Mcdowell Rd. #101, Naperville, IL 60563 | 2019-12-12 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | NORTHBROOK |
| Zip Code | 60062 |
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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.