Active NPI
Keri Alyse Jackson
- Behavior Analyst
- Joliet, IL
National Provider Identifier
1043830680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 3411 Grass Lake Dr
Joliet, IL 60435-8799 - Phone
- (708) 369-9062
- NPI assigned
- Apr 23, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | IL | Primary |
Addresses
Primary practice location
3411 Grass Lake Dr
Joliet, IL 60435-8799
Mailing address
3411 Grass Lake Dr
Joliet, IL 60435-8799
Phone (708) 369-9062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587600000000",
"number": "1043830680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3411 GRASS LAKE DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604358799",
"telephone_number": "708-369-9062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3411 GRASS LAKE DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604358799",
"telephone_number": "708-369-9062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KERI",
"middle_name": "ALYSE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-23",
"last_updated": "2020-04-23",
"certification_date": "2020-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.