Kenyetta N. Broughton-Floyd
Individual provider Active NPI Developmental Therapist · Park Forest, IL
NPI 1104030139 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1104030139
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- License
- KB52980401P (IL)
- Practice address
- 201 Lester Rd
Park Forest, IL 60466-2013 - Phone
- (312) 238-9128
- NPI assigned
- May 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KB52980401P | IL | MD | Developmental Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | |||
| Developmental Therapist | 222Q00000X | KB52980401P | IL | Yes |
Addresses
Primary practice location
201 Lester Rd
Park Forest, IL 60466-2013
Mailing address
PO Box 992
Park Forest, IL 60466-0992
Phone (312) 238-9128
Other providers in Park Forest, IL
- Blackbag Home Physician Service LLC
- Bombeau Lux, LLC
- Sandra Dionne Brand
- Teri Broadnax
- Sandra Brooks
- Brown Bear Early Intervention LLC
- Anita Marie Brown
- Ariana Brown
- Kenneth Brown
- Lavetta Marie Brown
All providers in Park Forest, IL · Developmental Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.