Active NPI
Mi'Kel Jacobs
- Behavior Technician
- Oak Lawn, IL
National Provider Identifier
1093663148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- J212-5570-5302
- Practice address
- 5540 W 111TH St
Oak Lawn, IL 60453-5574 - Phone
- (708) 634-0821
- NPI assigned
- Mar 16, 2026
- Sex
- Male
- 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 Technician | 106S00000X | J212-5570-5302 | IL | Primary |
Addresses
Primary practice location
5540 W 111TH St
Oak Lawn, IL 60453-5574
Mailing address
996 Royal Marco Way
Marco Island, FL 34145-1829
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J212-5570-5302 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773619200000",
"number": "1093663148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "996 ROYAL MARCO WAY",
"city": "MARCO ISLAND",
"state": "FL",
"postal_code": "341451829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5540 W 111TH ST",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604535574",
"telephone_number": "708-634-0821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "MI'KEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-03-16",
"last_updated": "2026-03-16",
"certification_date": "2026-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "J212-5570-5302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Lawn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.