Individual
JACK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
917 SHERWOOD DR STE 201, LAKE BLUFF, IL 60044-2235
(877) 486-4140
Mailing address
426 W BELMONT AVE APT 807, CHICAGO, IL 60657-4721
(773) 386-4024
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-45283
IL
106E00000X
Assistant Behavior Analyst
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Other
Enumeration date
12/12/2019
Last updated
08/12/2021
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