Kaitlyn J Proctor, RBT-19-82835

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-19-82835 Issued in IL

Practice address

21000 S Frankfort Square Rd Ste D
Frankfort, IL 60423

Phone

(814) 469-1500

NPI assigned

Apr 4, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1265994420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21000 S FRANKFORT SQUARE RD STE D",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604239386",
            "telephone_number": "814-469-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 S FRANKFORT SQUARE RD STE D",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "60423",
            "telephone_number": "814-469-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Revere Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Northbrook",
            "state": "IL",
            "postal_code": "600628005",
            "country_code": "US",
            "telephone_number": "847-306-9843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "KAITLYN",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "RBT-19-82835",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-04",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "RBT-19-82835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Frankfort, IL
• Providers in Frankfort, IL by specialty
• Behavior Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.