Jennifer Kerelko, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

278-140 Issued in WI

Practice address

1575 Allouez Ave
Green Bay, WI 54311-5639

Phone

(920) 857-9041

NPI assigned

Jan 31, 2019

Last updated

Jan 31, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Caravel Autism Health, LLC

  • Behavior Analyst
  • Green Bay, WI
  • NPI 1588993091
  NPD (past)
• Integrated Developmental Services, Inc

  • Mental Health Counselor
  • Madison, WI
  • NPI 1528025954
  NPD (past)

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548892800000",
    "number": "1275098550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 ALLOUEZ AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 ALLOUEZ AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115639",
            "telephone_number": "920-857-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERELKO",
        "first_name": "JENNIFER",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "278-140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "JOHNSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan K Kenney, AU.D.
• Mark Roger Kenton, RN, BSN
• Jennifer Keomanyvong
• Helen Louise Keough, R.N.
• Stephanie Keranen, COTA
• Tricia Ann Kerker, LPC
• Aliece Ann Kerscher
• Kyle Kershek, LPC
• Cynthia Vida Ketter, PHYSICAL THERAPIST
• Rebecca L Ketterhagen, PA

• Behavior Analyst in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.